Exhibit A
IN THE GENERAL COURT OF JUSTICE
SUPERIOR COURT DIVISION
STATE OF NORTH CAROLINA
COUNTY OF NEW HANOVER
CIVIL ACTION NO. 96 CVS 0059
The undersigned hereby certifies the following:
I wish to opt out of this class action. I am doing so voluntarily and upon advice of counsel.
I filed a motion to opt out on _______________________ .
I am represented by: _____________________________.
The residential dwelling covered by this election:
______________________________________________
(Street address, city, state, zip code)
______________________________________________
(Other legal description if no street address)
Owner(s):______________________________________
EIFS or synthetic stucco used on this dwelling was manufactured by:
______________________________________________
Name of EIFS manufacturer
The basis of my identification of the EIFS manufacturer is:
______________________________________________
______________________________________________
(Identification may be made on the basis of manufacturer warranty, inspection reports, bills of sale, purchase orders, leftover product, etc.)
Undersigned hereby swear(s) under penalty of perjury that all of the information provided herein is true and accurate.
Signature(s):
________________________________ Date: ____________
________________________________ Date: ____________