Reimbursement of Warrant Fees/Failure to Appear Fees from St. Louis County Complete this form if you wish to receive a refund of Warrant Fees and/or Failure to Appear Fees you have paid to St. Louis County since October 27, 2012 to December 4, 2020*.ClaimFormNoClaimant ID 1. CLASS MEMBER INFORMATIONName:* First Middle Initial Last Current Mailing Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Phone:*Please Certify* I hereby give assurances that the information I am providing is correct. CAPTCHAUnique ID*Pursuant to this settlement, you will receive $75.00 if you are one of the first 5000 claimants to make your claim and if you are not one of the first 5000 claimants to make a claim you will receive $50.00.NameThis field is for validation purposes and should be left unchanged.