Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40008 Filed 05/09/22 Page 1 of 35
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`EXHIBIT 1
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40009 Filed 05/09/22 Page 2 of 35
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`Auto Dealer Settlement Administrator
`P.O. Box 43501
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`Providence, RI 02940-3501
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`AZ4
`
`«Barcode»
`Postal Service: Please do not mark barcode
`
`Claim#: AZ4-«Claim8»-«CkDig»
`«Firstl» «Lastl»
`«Addr1» «Addr2»
`«City», «St» «Zip»
`«Country»
`
`UNITED STATES DISTRICT COURT FOR
`THE EASTERN DISTRICT OF MICHIGAN
`In re Automotive Parts Antitrust Litigation
`No. 12-md-02311
`
`Must Be Postmarked
`No Later Than
`April 17, 2020
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`■
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`Proof of Claim
`CHANGE OF ADDRESS (ONLY IF DIFFERENT FROM ABOVE)
`
`Primary Address
`
`Primary Address Continued
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`City
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`[I]
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`State
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`Zip Code
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`Foreign Province
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`Foreign Postal Code
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`Foreign Country Name/Abbreviation
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`Your automobile dealership can make a claim for money benefits if it purchased new vehicles and/or certain parts for resale
`containing: Access Mechanisms, Air Conditioning Systems, ATF Warmers, Automotive Hoses, Automotive Lamps, Automotive
`Steel Tubes, Bearings, Body Sealing Products, Brake Hoses, Ceramic Substrates, Constant Velocity Joint Boots, Electronic
`Power Steering Assemblies, Exhaust Systems, Fuel Injection Systems, Heater Control Panels, HID Ballasts, Ignition Coils,
`Instrument Panel Clusters, Interior Trim Products, Occupant Safety Restraint Systems, Power Window Switches, Radiators,
`Shock Absorbers, Side Door Latches, Spark Plugs, Steering Angles Sensors, Switches, and Valve Timing Control Devices
`manufactured by one or more of the Settling Defendants and/or their predecessors, subsidiaries and affiliates or those alleged
`to be their co-conspirators in the District of Columbia or one or more of the following states: Arizona, Arkansas, California,
`Florida, Hawaii, Illinois, Iowa, Kansas, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska,
`Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, South Carolina, South Dakota,
`Tennessee, Utah, Vermont, West Virginia, and Wisconsin. These purchases must have been made between January 1, 1990
`and August 12, 2019. If your dealership filed a valid Proof of Claim in the first, second, or third round of dealership
`settlements in this litigation, you may rely on that Proof of Claim and do nothing further to participate in the current
`settlements.
`
`You may submit a claim online at www.AutoDealerSettlement.com or you may print and mail this form. Claims must be
`postmarked or submitted online by April 17, 2020.
`
`
`Are you submitting a claim on behalf of a dealership group or an individual dealership?
`0 Dealership Group
`O Individual dealership
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`*AZ4ONE*
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`1
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`FOR CLAIMS [I] ce[IJ Q ooc
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` OB
`PROCESSING
`ONLY
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`Q LC
`Q REV
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`Q RED
`Q A
`Os
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40010 Filed 05/09/22 Page 3 of 35
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`Dealership/Group Name (This is who payment will be made to):
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`D/B/A for Dealership:
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`State License/Registration Number for Dealership:
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`Primary Address
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`Continuation of Primary Address
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`City
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`Email Address for primary contact
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`Area code
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`Telephone number
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`—
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`—
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`VEIDCLEPURCHASES
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`State
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`I I I
`[I]
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`Zip Code
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`0
` Fill in the circle if you previously submitted a claim in 2015/2016
`and are submitting supplemental information
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`If you filed a claim in a previous Round of Settlements, please list your claim ID(s) below.
`
`Round 1 Claim ID:
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`Round 2 Claim ID:
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`Round 3 Claim ID:
`
`
`Please provide the following information for new vehicles your dealership purchased in the states listed above from
`January 1, 1995 to November 15, 2017. You may either provide information by dealership location or aggregated for your
`dealership group by state.
`0 I am submitting information individually for each dealership
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`0 I am submitting information for all dealerships aggregated by state
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`Number of Vehicles Purchased
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`The amount a dealership may be entitled to under these Settlements will depend on the number, make, and model of vehicles
`purchased during the relevant period.
`
`To show how many vehicles your dealership(s) purchased, please submit the year-end OEM financial statements for
`each OEM from which you purchased new vehicles for each year in the states listed above from 1990 to 2019, AND
`provide the following information. You may print and attach more pages for any given year
`
`*AZ4TWO*
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40011 Filed 05/09/22 Page 4 of 35
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`Year of Purchase - 1990
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`Model (not sub-model)
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`Number Purchased
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`*AZ4THREE*
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`3
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40012 Filed 05/09/22 Page 5 of 35
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`Year of Purchase - 1991
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`Model (not sub-model)
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`Number Purchased
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`*AZ4FOUR*
`■
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`4
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40013 Filed 05/09/22 Page 6 of 35
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`Year of Purchase - 1992
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`Model (not sub-model)
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`Number Purchased
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`*AZ4FIVE*
`■
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`5
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`You may attach copies of this page if you need
`to claim additional ourchases for this vear.
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`■
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40014 Filed 05/09/22 Page 7 of 35
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`Year of Purchase - 1993
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`Model (not sub-model)
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`*AZ4SIX*
`■
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`6
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`■
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40015 Filed 05/09/22 Page 8 of 35
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`Year of Purchase - 1994
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`Model (not sub-model)
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`*AZ4SEVEN*
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`7
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`■
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`

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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40016 Filed 05/09/22 Page 9 of 35
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`Year of Purchase - 1995
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`*AZ4EIGHT*
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`8
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`■
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40017 Filed 05/09/22 Page 10 of 35
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`Year of Purchase - 1996
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
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`Model (not sub-model)
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`*AZ4NINE*
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`9
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`■
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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40018 Filed 05/09/22 Page 11 of 35
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`Year of Purchase - 1997
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
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`*AZ4TEN*
`■
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`■
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`

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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40019 Filed 05/09/22 Page 12 of 35
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`Year of Purchase - 1998
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`Dealership/Group Name:
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`State Vehicles Purchased
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`Make
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`OEM Dealer ID Number
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`I I I I I I I I I I I I I ITJ
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`*AZ4ELEVEN*
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`11
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`You may attach copies of this page if you need
`to claim additional purchases for this year.
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`■
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`

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`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40020 Filed 05/09/22 Page 13 of 35
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`Year of Purchase - 1999
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`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWELVE*
`■
`
`12
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40021 Filed 05/09/22 Page 14 of 35
`
`Year of Purchase - 2000
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
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`
`
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`
`
`
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`
`
`
`
`
`
`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4THIRTEEN*
`■
`
`13
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40022 Filed 05/09/22 Page 15 of 35
`
`Year of Purchase - 2001
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`
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`
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`
`
`
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`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4FOURTEEN*
`■
`
`14
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40023 Filed 05/09/22 Page 16 of 35
`
`Year of Purchase - 2002
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4FIFTEEN*
`■
`
`15
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40024 Filed 05/09/22 Page 17 of 35
`
`Year of Purchase - 2003
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4SIXTEEN*
`■
`
`16
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40025 Filed 05/09/22 Page 18 of 35
`
`Year of Purchase - 2004
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4SEVENTEEN*
`■
`
`17
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40026 Filed 05/09/22 Page 19 of 35
`
`Year of Purchase - 2005
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4EIGHTEEN*
`■
`
`18
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40027 Filed 05/09/22 Page 20 of 35
`
`Year of Purchase - 2006
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4NINETEEN*
`■
`
`19
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40028 Filed 05/09/22 Page 21 of 35
`
`Year of Purchase - 2007
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
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`Number Purchased
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`Number Purchased
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTY*
`■
`
`20
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40029 Filed 05/09/22 Page 22 of 35
`
`Year of Purchase - 2008
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
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`Number Purchased
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`Number Purchased
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTYONE* 21
`■
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40030 Filed 05/09/22 Page 23 of 35
`
`Year of Purchase - 2009
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
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`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTYTWO*
`■
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`22
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40031 Filed 05/09/22 Page 24 of 35
`
`Year of Purchase - 2010
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
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`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTYTHREE*
`■
`
`23
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40032 Filed 05/09/22 Page 25 of 35
`
`Year of Purchase - 2011
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTYFOUR*
`■
`
`24
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40033 Filed 05/09/22 Page 26 of 35
`
`Year of Purchase - 2012
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTYFIVE*
`■
`
`25
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40034 Filed 05/09/22 Page 27 of 35
`
`Year of Purchase - 2013
`
`■
`
`Dealership/Group Name:
`
`State Vehicles Purchased
`
`Make
`
`OEM Dealer ID Number
`
`I I I I I I I I I I I I I ITJ
`~~~~~~~~II I I I I I I I I I I I I
`I I
`I I
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`Model (not sub-model)
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`Number Purchased
`
`*AZ4TWENTYSIX* 26
`■
`
`You may attach copies of this page if you need
`to claim additional purchases for this year.
`
`■
`
`

`

`■
`
`Case 2:12-md-02311-SFC-RSW ECF No. 2207-3, PageID.40035 Filed 05/09/22 Page 28 of 35
`
`Ye