Potential Class Action Member Information Form
Massachusetts Drug Lab Scandal (Annie Dookhan/Sonja Farak cases)

*PLEASE NOTE: Providing the information requested below is entirely voluntary and does not affect your eligibility for monetary compensation. This form has been created in response to the inquiries of many potential class members who wanted to make sure their cases were addressed appropriately.
Sign in to Google to save your progress. Learn more
Email *
Your name *
What was your name at the time of prosecution for your vacated drug case(s) (if different)?
What is your date of birth? *
MM
/
DD
/
YYYY
What is your mailing address? *
What is your phone number? *
Did you receive a letter from the Supreme Judicial Court notifying you of a dismissal of at least one criminal conviction or continuation without a finding due to the misconduct of Annie Dookhan or Sonja Farak? *
If yes to the previous question, please provide the mailing address on the letter (if different from your mailing address you provided above)
Please provide the county(ies) and docket number(s) of the case(s) that have been vacated, if you know
Which, if any, of the following fees/fines do you believe you paid in connection with the vacated case(s) (check all that are applicable):
Total amount of fees/fines paid, if you know
What documents or other proof do you have that you made a case-related payment (for example, receipts, witnesses, bank statements, etc.)?
Have you filed a motion for refund of any case-related payments in the court where you were convicted?
Clear selection
If yes, please provide the current status of the refund motion (for example, has a decision been made?)
Have you received a refund of any case-related payments? If so, please state when, how much, and which fees/fines it was for.
If you're found to be eligible for payment under this class action lawsuit, please provide an address for where it should be sent. *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy