TLS - Chicken Overcharge: Designated Agent Authorization (Individual)

DESIGNATED AGENT AUTHORIZATION (Individual)

Chicken Overcharge / Broiler Chicken Antitrust Litigation Settlement Claim
Chicken Overcharge / Broiler Chicken Antitrust Litigation, on behalf of End-User Consumer Plaintiffs, concerning claims against certain poultry producers and affiliated entities who are parties to the New Settlements in the case entitled:In re: Broiler Chicken Antitrust Litigation (End-User Consumer Plaintiff Class),Case No. 1:16-cv-08637 (N.D. Ill.), United States District Court for the Northern District of Illinois, Eastern Division.These Settlements apply only to the New Settling Defendants and do not dismiss claims against other non-settling defendants in the broader litigation.
I, First Name * Last Name * hereby retain Tanvi K. Sheth of T.K. Sheth Law LLC d/b/a The Law Shed, and their team (“Attorney”), to investigate and, if appropriate, pursue claims on my behalf in connection with the Chicken Overcharge / Broiler Chicken Antitrust Litigation Settlement.

If the Settlement Administrator later requires a Taxpayer Identification Number for payment or tax reporting, I agree to provide it via a secure IRS Form W-9 upon request.
I grant a limited power of attorney to Attorney for the purpose of executing all documents and papers that I would execute relating to the Chicken Overcharge / Broiler Chicken Antitrust Litigation Settlement Claim. This limited power of attorney includes the authority to request any records necessary to support my application. It also includes the authority to use my signature, including an image of my signature (provided below).

I authorize and instruct Attorney to use this limited power of attorney to:
(i) direct third-party payors to send all gross recovery payments to the Attorney; and
(ii) endorse my name to any checks or other instruments payable to me and take all other actions deemed appropriate by the Attorney in order to receive gross recovery payments into a trust account maintained by Attorney for the benefit of their clients.
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DESIGNATED AGENT AUTHORIZATION (Individual)