Molina et al v. Ace Homecare LLC

Middle District of Florida, flmd-8:2016-cv-02214

Exhibit Opt-In Consent Forms 1

Interested in this case?

Current View

Full Text

ACTIVE ADULT CARE 20001 / 0002 11 / 08 / 2017 9: 45 AM FAX 57111228 5 PagelD 489 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. & 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 ' Tampa, Florida 33602 Main Number: (813) 224 - 043 ] Facsimile: (813) 229 - 8712 E - Mail: bhil @ wſclaw. com triciaw @ wfclaw. com Name: Name: _ CLAUDIA ? ALUR Address: / SUL Ternglade _ Dne City. Limia State し Zip 33SIH Telcphonc: E - Mail: 11 / 08 / 2017 9: 45 AM FAX 57111228 ACTIVE ADULT CARE 20002 / 0002 5 PagelD 490 PageID 417 | Feb 27 a 3 - 24 - 16. 2 Pay Pervln. te 23 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Honecare, LLC, and was not paid minimum wage between; or 73 From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et sey. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent ne for all purposes in this action. Signature: Claudio Alwr Signature: Date: _ a / 1 / is Cacak VH164C02AAGTFUW DIGUNAKIH 52 fikEd S3 / 09 / 17 PAFBA55 RAAFIAA91 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. S 216 (6) - - FIIY ' n t Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciawawfclaw. com * * * TIR. . . . " . - - - - - - - - - - - - . . . . . Name: Name: Javier Alvarado Address: _ 1837 lwrn Arthur Dr. City: _ Valrico _ State _ FI Zip 3394 Address: State Telephone: E - Mail: - ET - 1 CastEd. GFK28234J FENN BOEHMERI 39 - 2 Fied d659147 Pagge4P $ pagABELA A92 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action, Signature: Dates _ Joli8 | | 1 Date: " | 1 - - - - - - - - - - - - - - - - - - - - - TLIK. LOL. - - - - - - - - - - - - - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . Casest Filed 12 / 19 / 17, Page 5 of, 55 _ Page | D. 493 Heumert 63 - 2 ' Fired 9 / 05717 ' Page 1 of 2 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. S 216 (b) Complete and return to: · Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com - . . . - - - - - . . . - - . . . . . . . . LUIS Name: CarD) Ander Addres: 529 Cortland Drive City: DaYNDON _ State FL V SST VLTA: . . . 2. . . - .: " - - . I - - - - - - zip Telephone: E - Mail: L. A. Lulusta MLILLVEN. ALS L ' Page 5 Filed 12 / 19 / 17, DOCUumment 63 - 2 ' Fiedo970517 ' Pagě 2 Casease - 8 យា f 5. PageļD 494 2 PageID 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: Condor) Dates _ 1113 la UN SISU. . . . . . - . - - - - - - L - u. d. wi. ILL. . l. Lukas 5 PagelD 495 PagelD 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. S 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com Name: ANTONIA ARAGON Address:) 23 0 + JOAVAGJIS KD (TOA VAJIN) City: HADE CITY _ State _ ELL _ Zip 3355 Telephone: E - Mail: 5 PageID 496 PageTD 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: Date: _ J2 - 4 - JOZ Date: Case 8: 16492330JPOUT GWOCDOANHēAC 63 - 5llefied ' o3 / 05 / 17 Page 1 of 2 PageID 416 ed, 12 / 19 / 17. Page 9 of 55 PagelD 497 Case 3: 16 - CV - 0221 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, V. CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. - - - - - - - - - - - - - - . - . . . . . - . . . - - - CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhillawfclaw. com triciawawfclaw. com - . . . - . . . . . . . . . . . . . . . . - . . . . . . . . . . . - . . . ! Name: Name: _ Chacles. Ashe Address: 9112 Simeon. Dr. City: Land O ' Lakes _ State _ FI Telephone: Zip _ 3Y 3 P E - Mail: Au - l - . * - - - - - ni - series. " Flea 09 / 05 / 17 Page 2 of 2 PageID 417 Case 8f8 - & 1622 PIDANIOWYWGWoqpment A - 83 - 5iled 12 / 1917, Page 10 of 55 PageID 498 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. • 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. S 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: I Dates 10 / 41 Date: - - - - - - - - . . - . . . . . . . . - - - - ' . I. . - . . . - - . L. JPle. - - هيله - ش - انقطعت لا . - ase8: 165CV 022143JDWETGW pocument 79 - 2 Filed 12 / 19 / 17 Page 11 of 55 PageID 499 case 3: 16 - CV - 02214 - DW - TGW Document 63 - 2 Filed 09 / 05 / 17 Păge 1 of 2 PageTD 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, - . - - Irsk. ratr CASE NO .: 8: 16 - cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. 216 (b) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com - - - - - - - - - - - - - - - - - - Name: - - - Name: Omar ATTO Adres: 11906 boytree DL RHer City: _ LIN CIVIC _ State _ FIL Zip _ 33509. . . . . . . . . . . . . . . Telephone: E - Mail: I J. R. - - - . - . - . - . - * * * - - Case 8: 16 - G4 - 02214 - JRA - IGW, Pocument 79 - 2 Filed 12 / 19 / 17. Page 12 of 55 PageID 500 case 8: 16 - cv - 02214 - IDW - TGW Document 63 - 2 ' Filed 09 / 05717 Page 2 of 2 PageTD 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. S 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: OYNou Ma Signature: Date: VOLQ4 | | 1 - - . . . . . . . - . . . . . - . ", Li. - - - - - - . L. - - Littl - i - I " . . . . LLIDAADIGWGRoquente Figh az ANZAPAGHARANA. 1917 Page 13 of 55 PageID 501 19 / 05 / 17 Page 1 of 2 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, - - - - - - - - - - - - - - - - - - - - Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. & 216 (b) Complete and return to: * r Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciawawfclaw. com Name: _ Laurie A. Baker. Address: 4to N. Verona Ave City: Avon fecek _ State _ FL LP, L - EL _ Zip _ 33825 Telephone: E - Mail: kaptr Cas€8 $ fcBo22422IDADVGVGVDoDomener7063 - 2Fileitta VIDI / 17 PaggelA af SpiegelQ1502 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. O, Signature: Sacchiff Signature: Date _ u / 23 / 7 Date: . . . ! - - . . . . . Lw. . . . ' . . . ' -, ' t - i - ' . - - - - . -, LL LI. . . ANDI. - - - - | 5 PageID 503 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, V. CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. Kimberly Be att CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C, 216 (6) - - - . " ar. . . . . . . . . - - - - - Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciawawfclaw. com Name: Name: Kimberly Bentz Address: 3853 Hadden. Ter: City: North Port _ State _ PA u. . - . ' . LL. - P. E. . . . . AL. . . . . . . . . . . . . . . . . ILMA. Ieu - la - . Zip 39287 Telephone: E - Mail: 5 Pagel3 SU4. 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action, Signature: _ Lear, buly sbor Dates _ ie / 16, dol7 _ Signature: Date: CasaSF161 & - O2214. IDWMFTAW DƏeament7032 filled DN29 / 17 Page 1pff BagdgAD6505 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW — ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, mw - - - - - - Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. 216 (b) Complete and return to: - . . . LAR — — — . Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com Name: Name: Synthia 14 13thea KAN address: as N. Berser Rd City: CleistoN _ State _ P Zip _ ਤ) Address: - - - . m n. . . ' . ' n ' ' - - . . . . . . . . . . . . . . - JIL Telephone: E - Mail: - Star, t. e. - - L. - - . . . . . . - LA Casabel8 - - 0202A1DWYWGWDDIOmeeh7922 FilfellMIDA7 Page 18pf pasage49 506 From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in thisfaction. Signature: | migË utLES Date: _ 10 = 1940 - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - IL. - - . - . - . - . - . - - - - - . - - . lis. must 0. 10 - cv - 02214 - JDW - TGW Document 63 - 1. Filed 99KQ5417pracęg off 65 PageDD4507 PageID 412 Case 8: 16 - cv - 02214 - JBW - TCW - D©timent 70eant filed 12 / 19 / 17 Page 20 of 55 PagelU JUU 1. PURPOSE OF THIS NOTICE The purpose of this Notice is to inform you that you are eligible to participate in a lawsuit against Defendants, and to inform you of the procedure you must follow to participate in the lawsuit if you so desire. 2. DESCRIPTION OF THE LAWSUIT This lawsuit is brought by Toni Molina, Erica Tovar, Tara Ward, Ly Nguyen, Consuelo Powell, Donald Hall, and Debbie Burgess, former employees of Defendants, on behalf of themselves and all other similarly - situated employees ("Plaintiffs") . Plaintiffs assert that Defendants failed to pay them minimum wage in violation of the FLSA. Further, Plaintiffs allege that Defendants failed to compensate them from February 29, 2016 until March 13, 2016. Defendant, Ace Honiecare does not deny that Ace Homecare failed to pay some of the employees minimum wage. However, Defendants, Arthur Barlaan and Joy Barlaan do deny that they should be responsible for Ace Homecare's failure to pay minimum wage. This lawsuit is currently in the early pretrial stage in the United States District Court for the Middle District of Florida in Tampa, Florida. The Court overseeing this lawsuit has not made any determination whether anyone is entitled to any compensation. * * * * * * * PERSONS ELIGIBLE TO PARTICIPATE IN THE LAWSUIT You are eligible to join this lawsuit if you worked as a nurse employed by Ace Homecare, LLC, and were not paid minimum wage between February 29, 2016 to March 13, 2016. You are also eligible to become part of this lawsuit if you worked as any other type of employee for ACE Homecare, LLC and were not paid minimum wage between February 29, 2016 to March 13, 2016. YOUR CHOICE TO PARTICIPATE IN THE LAWSUIT 4. - - - - - - - The named Plaintiff seeks to sue on behalf of any and all other persons employed by Defendants who did not receive at least minimum wage for all hours worked, for the period February 29, 2016 to March 13, 2016. If you fit the definition above, you may choose to join this action by mailing, faxing, or emailing the attached Consent Form to Plaintiffs ' Counsel (at the address below) for filing with the Court. If you are reading this Notice at your place of employment, you may contact Plaintiffs ' Counsel directly for a copy of the Consent Form: Brandon J. Hill, Esq. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602. Direct Dial: (813) 337 - 7992 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com E - Mail: mk @ wfclaw. com Case 8: 16 - 55032AGWDWIELWEDocument 63 - 1 Filed 09 / 05 / 17 Page 4 of 6 PageID 413 Case 8: 16 - cv - 02214 - SBRAGADOqcument 79 - 2 Filed 12 / 19 / 17 Page 21 of 55 PageID 509 The Consent Form must be received by Plaintiff's Counsel on or before form to Plaintiffs ' counsel by. for you to participate in this case. If you fail to return the completed consent It is entirely your own decision whether or not to join this suit. you may not be able to participate in this lawsuit. 5. YOUR RIGHT TO DECLINE PARTICIPATION IN THIS LAWSUIT lawsuit you do not have to do anything at this time. A recovery of money is not certain for those You are not required to participate in this lawsuit. If you do not want to participate in this who do participate in the lawsuit. However, if you do not participate in the lawsuit, you will not be eligible to receive any portion of any recovery that might be obtained by the Plaintiffs. If you choose not to join this lawsuit, you are free to retain your own attorney and file your own lawsuit. EFFECT OF JOINING THE LAWSUIT 6. If you join this lawsuit, you will be bound by any judgment of the Court, whether favorable or unfavorable. If you choose to join this suit, you may be required to provide information, sit for depositions and testify in Court while the suit is proceeding. If requested, you will be provided with a translator if English is not your first language at no charge to you. By joining this lawsuit, you designate the named Plaintiff as your agent to make decisions on your behalf concerning the litigation, the method and manner of conducting this litigation, the entering of an agreement with Plaintiffs ' counsel concerning attorneys ' fees and costs, and all other matters pertaining to this lawsuit. These decisions and agreements made and entered into by the representative Plaintiffs will be binding on you if you join this lawsuit. The attorneys for the Plaintiffs may be entitled to receive the payment of attorneys ' fees and costs in this lawsuit should there be a recovery or judgment in Plaintiffs ' favor. If there is no recovery or judgment in Plaintiffs ' favor, you will not be responsible for any attorneys ' fees. 7. ANY RETALIATION IS FORBIDDEN BY FEDERAL LAW because you have joined this lawsuit. Therefore, Defendants are prohibited from discharging you Federal law prohibits Defendants from firing or in any way discriminating against you or retaliating against you in any other manner because you choose to participate in this lawsuit. Participating in the lawsuit does not excuse current employees from complying with Defendants existing policies and work rules. WAIVER OF RIGHTS NOT PERMITTED Under Federal Law, you may not waive your right to recover wages and other damages under the Fair Labor Standards Act unless your employer has obtained approval by theU.S. Department of Labor or a Court of competent jurisdiction. Even if you have signed a contract that prohibits you from participating in this particular case, you are still entitled to assert your right to recover wages and / or claims for retaliation under the Fair Labor Standards Act. YOUR LEGAL REPRESENTATION IF YOU JOIN PageID 414 Case 8: 16 - CV - 02214 - SBURGWDIROFument 79 - 2 Filed 12 / 19 / 17 Page 22 of 55 PagelD 510 If you participate in this lawsuit, you will be represented by the following attorneys: BRANDON J. HILL Florida Bar Number: 37061 Direct No .: 813 - 337 - 7992 WENZEL FENTON CABASSA, P. A. 1110 North Florida Ave ., Suite 300 Tampa, Florida 33602 Main No .: 813 - 224 - 0431 Facsimile: 813 - 229 - 8712 Email: bhill @ wfclaw. com Email: mk @ wfclaw. com Attorneys for Plaintiff and CHAD A. JUSTICE Florida Bar Number: 121559 Direct No. 813 - 254 - 1777x106 BLACK ROCK TRIAL LAWYERS 201S Westland Avenue Tampa, Florida 33606 Main No .: 813 - 254 - 1777 Facsimile: 813 - 254 - 3999 E - mail: chadjustice @ blackrocklaw. com E - mail: prelitigation @ blackrocklaw. com Co - Counsel for Plaintiffs 10. FURTHER INFORMATION Further information about this Notice, the attached Notice of Consent form, the deadline for filing your form, or any other aspect of this lawsuit may be obtained by contacting Plaintiffs ' counsel at the number and address stated above. If you desire to communicate with the attorneys representing Defendants, you can contact: Stanford R. Solomon Florida Bar No. 302147 Blake J. Fredrickson Florida Bar No. 91086 THE SOLOMON LAW GROUP, P. A. 1881 West Kennedy Boulevard Tampa, FL 33606 Telephone: (813) 225 - 1818 Facsimile: (813) 225 - 1050 Email: ssolomon @ solomonlaw. com Case 81 & SYDVAZIGDWIGW Document 63 - 1 Filed 09 / 05 / 17 Page 6 of 6 PageID 415 Case 8: 16 - CV - 02214DVAZIGOPocument 79 - 2 Filed 12 / 19 / 17 Page 23 of 55 PageID 511 Email: bfredrickson (asolomonlaw. com - - . . . - du - - - - - Case 8: 16 - 6921GNOREWDocument 63 - 2. Filed 09 / 05 / 17 Page 1 of 2 PageID 416 Case 8: 16 - CV - 0221496W2MGORFeument 79 - 2 Filed 12 / 19 / 17 Page 24 of 55 PagelD 512 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. g 216 (6) Complete and return to: Brandon J. Hill, Esquire, Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com - - - - - . . . Name: _ Jenvinker Bishop Address: 1533 Atwood fr City: Wesley dalupu Telephone: E - Mail: Zip 33945 Case 8: 15 - SHOW2MGODI GWDocument 63 - 2 Filed 09 / 05 / 17 Page 2 of 2 PageID 417 Case 8: 16 - CV - 02214 - SHW241C \ VDINGcument 79 - 2 Filed 12 / 19 / 17 Page 25 of 55 PagelD 513 From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or position besides as a nurse and was not paid minimum wage ., 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: _ AB Signature: Dato: _ rohelia Date: - - . * * * Case 8: 16 cv - 02214 - JRW JGW ., Document. 7952, Case 8: 16 - CV - U2214 - IDW - TGW Document ' 63 - 2 ed. 12 / 1 iled 09 / 05 / 17 55 Pagel Pagerbrof Page ។ UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION Ymunur TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW La Jusler ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. E 216 (6) LI JIJI - t - . - - - - - - . * * Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciawawfclaw. com Name: TAMÁS P. Blandssy Address: / SAD koll /) 6 MKaboul DR. City: _ / A. RICO _ State _ F _ Zip _ 33SIY Address: . . . . . . . . . . . . . . . . . . . .: . . . . . 11:: IN ' — Telephone: E - Mail: - - - - - - . - . - . - . T. t - tu. - - d ' - - - - - - 515 Case 8: 16 - cy - 02214 - JDWETGW, . Document 79 - 2 Case 8: 16 - cv - 02214 - JOW - TGW Document 63 - 2 d 12 / 19 / 17 Page, 27 ěd 09 / 05 / 17 Page2 of 45 NO 1. & From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 16 YBS 2. * From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any Ta position besides as a nurse and was not paid minimum wage ., GENAVIORAL V COÉNITIV A 68ET O / RECTOR 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. g 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. annet. ua. sine forelbus Dumblıslız Signature: Date: - - - * > IF - - - - - - - - - - . . . . . . . . . . . . . . . - L - . . . . . . . . . . i. - - cal - LLA. . . - . -: L. K. n - - . . . I: . . . . . . . . Case 8: 16 - cv - 02214 - JAWATGW ., Document, 79 - 2 case 3: 16 - CV - 02214 - IDW - TGW Document ' 63 - 2 Eiled 12 / 19 / 17. Filèd 09 / 05 / 17 Page 1 of 2 ' Pagel416 Page, 28 gi UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, v. CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, u. v. . u - Y. I. . . . . - - Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (6) Complete and return to: Brandon J, Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com " ' ' " Turi L - . - - I ' . U Name: Name: _ SON ' A BU 220 SQ Address: 8, 7 Lake Betty Drive Citył ake Placid _ State Fl Zip 338 5 HTYHYT Telephone: E - Mail: - - - - . - . . - . . . HELPUYH4 - . . . . . . wwwmw wa. at. A. . J. L. . . . . . LLALL. . " . as & & 161€Y % D02A JDWETGW, Document. 79 - 2 Case 8 16 - cv - 02214 - IDW - TGw Document ' 63 - 2 iled 12 / 19 / 17 Filed 09 / 05 / 17 Paez 21 PageI4TH Page 29. af 55 PageIP, 517 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. unumque tinham 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C, S 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: Jonu BMJ Date _ 10 / 12 17 Signature: Date: . . ALL. . . . . . . . - - srit - - . . . - . . ': . ': - . - - - . - . - . - - - - - - Lucy ! . ' LL - ' . . . . - . - - . ' - - ' . ' . . . . . . . . . . unus - - . . Hr. Inti ' . AJI - AL. - - L. L. L. bii. intu - uni. 5 PageID 518 PagelĎ 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGw ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com Name: Name: _ BHy Buckley Adres: 401 LAHMA Civy: Mauchla _ sule _ L Address: 33873 Zip. . . . . . . 1. L. I. .: - (- - LU Telephone: E - Mail: - - - - - - 5 PageID 519 Pageld 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or (1 .) From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. rom. m. . 1 - A. . Signature. Terebrates - - P1117 Date: - - mm - Innri. - - II FL - . . . . . . L. - . LL: - - - - - - - - - - - - - Lu. Im. . ' . - - 1. . . . . . . - Ir - . . . Mun. . ., — - - - - - - 4. - - - - - . . . . . . . . . . . . - . - . - . . . ' . . . . 5 PageID 520 PagelD 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW 17 - * * Ar ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, - . - - - . . u. PLI LLUu - . - - - Defendant. - - - - - - - - - . . . . . . . . . .,, i - - - - - - - - - - CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (b) Complete and return to: - - - - - - Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wſclaw. com Name: Name: Debbie DursesS address: 2512 Saanse LDE City: Sebring _ State _ FL _ Zip _ 33 270 - - - - - - - . . . . . . . . . . . . . - 1. 21: - - - Address: Telephone: E - Mail: " ' . . " . . . . . . . – . . . . . L. - ' . . - . - . - . - . - is - in 5 PageID 521 PagelD 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: Dull - Burgus Date: _ 10 17 Signature: Date: Green. . - . - JL. - - . - L - - - - - - - - - - 11. rid. . . - . . . . . . .: - . . Janwo — — . . - Cass & a6 - FO - BZALA: PYMAGWwPPSALTRIA 7822 FÄRGBLIKA7 Page 146P6 KLASS47522 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - ev - 02214. JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (6) Complete and return to: Brandon J, Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com Name: Tiaa L. Rund - thagave Adres: P. O. Box H City: Indian Lakes Ehksitate _ Address: _ Zip _ 33855 Telephone: E - Mail: . . . . LA Catag cuments 8 Current 63 # d 1241 SA7 סד UN DD g No N 1, From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace IIomecare, LLC, and was not paid minimum wage between; or ܠܢ From February 29, 2016 to March 13, 2016 I worked for Ace Homccarc, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., (110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. () Signature Jua, Hngonte Date: _ Jolislə . * NA 5 PagelD 524. PageID 417 From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecaro, LLC, and was not paid minimum wage between; or as die From February 29, 2016 to March 13, 2016 1 - worked for Ace Homecare, LLC in any position besides as a qurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. $ 201, el seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any ENJudgmeiitby the Court or aby setlenient of this action. I hereby designate Wenzel Fenton Cabassa, PA, 113, 0. North Floride Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this actions HAN EN KRUIS IS EEN PLAATS MAAILMANENNTARA LAIN ir Signatura XIL * * fiatki ETHNitrurit te vin. * * * * Christianitation in ipsugasnya sebagai satu Á re SON adiecit Ment Ruinta e 5 PageID 525 PagelD 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. & 216 (6) Complete and return to: Brandon J. Hill, Esquire, Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com Name: Name: Lindsey Colsa Adres: _ OS Topkal Breeze Way City. Lampa Zip _ 33 e6 2 Address: Fr ', trum. d. . City: State - L. ' L ' . . . . . . . . . . . . Telephone: E - Mail: IL - P - L. A: AIL GLAVNI. - . L. 21. 31. 121. J .: ' - p. 1 Nov 30 17 10: 19a CARROLL 2397680008 5 PageID 526 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - Cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. & 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhillawfelaw. com triciawawfclaw. com Name: Names _ Angla M larell (Amy) Address: Gila shadur Clen was City: Fort Myes _ State _ A. ' zip _ 3313 Telephone: E - Mail: p. 2 Nov 30 17 10: 19a CARROLL 2397680008 5 PageID 527 PagelD 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature bustl Date _ 11 / 24 / 17 _ Signature: Date: 5 PageID 528 PagelD 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, TTT MITTININ Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, u Lu NuUJUILLAULUJ I. LL = Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. S 216 (b) Ir - . - - Complete and return to: - " - - . LA. . . . . . Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com - . . - - LM - FI - L 1. M ' - - . - . . Name: Name: Patrina. Carter Address: GOL S Delaney Av€ City: Avon Park _ State _ E [ a _ Zip _ 33FAS Address: Telephone: E - Mail: LI - - L. I. m. th, . . . . . . . . . . - at. L. L A. — — 5 PageID 529 PageID 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. - - ALL 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. & 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: TaUum la Dae _ 10 1517 Date: ITraniu - - - ur ' ' - DIE PL - - - - - - - - - - ' — u ., vnu. JR. - - - - - - -: " . ' - TAL - L - - - - - . lek + HY, " . . . . . . . . . . . all — i. PEL. J. . . – . . .: . . . " . - . L. - - - . - . Cases gG - QR214 ] AN SHAlyeft DAML: 763 - 2Fland 1848477 PREPRÉFPLAAS ' A330 AYAYAf5FEH 6 3 5 N UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, V. CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, ARTHWESTMEAE, LLC Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wſclaw. com triciaw @ wfclaw. com * * *, " - - - - - Name: Name: _ Qiche S. Castellanos Adres: 18SI MAHKew p # TIL City: Clewiston State a Zip _ 33FYD - - - - | r - * *: . . . - - Telephone E - Mail: - - - - r - J. - . . . - - L - - - - - - - - LLY ' . . ' . . . - - - - - - - - - Catašel6 - 28 - A281914DIOW GUWDPOEMAER78322 FWAetilad AWA7 Page 430£ pasage42531 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. S 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature. Aliás lliokllanas Dates _ Jo | | col17 Signature: Date: l - ES FLJUULILL - - - - - - - - - - - . J. J. - - - - - - - - - T. . I. - - - TFT. . . - . . AL ' - - r - - - ' va - - - p. 1 813 - 383 - 1296 Oct 16 17 07: 16p Clark 5 PageID 532 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant, CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. $ 216 (b) Complete and return to: Brandon J. Hill, Esquire, Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhillawfclaw. com triciawawfclaw. com 1ofreſi 7 Hoff - populasyon Name: Name: Le Ha Cſof IK Address: 717 - Ringston, (ĉust Ciy - Born ito Brash _ state Zip 33 573 Address: Telephone: E - Mail: _ p. 2 Oct 16 1707: 17p Clark 813 - 383 - 1296 5 PageID 533 PageID 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Honecare, LLC, and was not paid minimum wage between; or From February 29, 2016 to March 13, 2016 I worked for Ace Homccare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. $ 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature dentte Classic Signature: Date: Date: _ jof (6 / 17 fored 4 marthy Caseaga8 - 26 - 022241FÐIMVYDAWDocameeth7922 Mbeti 1905 / 17 Page 4602 HaRageAD534 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. E 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhillawfclaw. com triciawawfclaw. com ILL. LLALL. . . LEL. - I. Id - - Er www II. . . . A - . Name: Name: _ _ Panna Collins ZO63 foel (One HC City: Donedansture _ HA Zip _ 34L - SY8 Address: T ' . . . . - - ELI - - - - - - - - - - - Y. Telephone: E - Mail: - .: · le ' . . Casele 16 TIO22 - DADDNJIG NGWOgument. 79 - 2 filed 12 / 19 / 17, Page 47 of 55 PageID 535 CaseGI6 & V022 - DR - DVD \ AGUNGWOBEEtent 63 - 2 " Filed 09 / 05 / 17 Page 2 of 2 PagelD 417 From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. 201, et seq. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Siename kara delis Dae _ JO 517 Signature Date: - - - - . . . . . . . . ' L - u. - Literatur " i PinLYuirrel Case 8: 16 - cy - 02214 - JPW - IGW. Pocument 79 - 2. Filed 12 / 19 / 17 Page 48 of 55 PageID 536 P PageD 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGw ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. & 216 (b) . - Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciawawfclaw. com Name: Name: _ goleadas $ . Como A Addres: gol _ Stonlar R, # 309 Ciy - fasga _ stats _ th. Zip 3314 Telephone: E - Mail: Case 8: 16 - cy - 02214 - JPW - TGW. Document 79 - 2. Filed 12 / 19 / 17. Page 49 of 55 Pagelp 537 5 PageID 538 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. E 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. II IO North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciawawfclaw. com Names _ Patricia Conk In Address: 772 Andalusia Cord Blud City: Cape Coa _ State _ FL _ Zip _ 33709 Telephone: E - Mail: - - - - - - - - p. 2 Oct 1517 04: 39p Conklin 2392429709 5 PageID 539 PageID 417 1. Froin February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 1 worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. E 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: _ Pazzia Cunho Date _ tolis / 201) Signature: Date: - - - 5 PageID 540 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cy - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. E 216 (b) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com Name: Steven Cote Address: 23 Oid village CWAY City: Oldsamme State EL Zip _ 34014 Telephone: E - Mail: 5 PageID 541 PagelD 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. g 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action. Signature: LCI Signature: Date: 10 - 18 - 3017 5 PagelD 542 PageID 416 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION TONI MOLINA, ERICA TOVAR, TARA WARD, LY NGUYEN, CONSUELO POWELL, DONALD HALL and DEBBIE BURGESS, Plaintiff, CASE NO .: 8: 16 - cv - 02214JDW - TGW ACE HOMECARE, LLC, BRL INVESTMENTS, LLC, ARTHUR BARLAAN, and JOCELYN BARLAAN, Defendant. CONSENT TO JOIN COLLECTIVE ACTION Pursuant to the Fair Labor Standards Act, 29U.S. C. S 216 (6) Complete and return to: Brandon J. Hill, Esquire. Wenzel Fenton Cabassa, P. A. 1110 North Florida Avenue Suite 300 Tampa, Florida 33602 Main Number: (813) 224 - 0431 Facsimile: (813) 229 - 8712 E - Mail: bhill @ wfclaw. com triciaw @ wfclaw. com. . . Name: Philip Cronk: C Addres: 1954 Indigo - La Mes Cir City: _ Marley _ State _ _ Zip _ 3419 - - - - Address: Telephone: E - Mail: MALL WILL. . . ledi. - . 5 PageID 543 PagelD 417 1. From February 29, 2016 to March 13, 2016 I worked as a nurse employed by Ace Homecare, LLC, and was not paid minimum wage between; or 2. From February 29, 2016 to March 13, 2016 I worked for Ace Homecare, LLC in any position besides as a nurse and was not paid minimum wage. 3. I understand that this lawsuit is brought under the FLSA, 29U.S. C. 29U.S. C. g 201, et seg. I hereby consent, agree, and " opt in " to become a plaintiff herein and to be bound by any judgment by the Court or any settlement of this action. I hereby designate Wenzel Fenton Cabassa, P. A ., 1110 North Florida Avenue, Suite 300, Tampa, Florida 33602, to represent me for all purposes in this action, Signature: Date: ulelin Date: - - - . - . - . . - Lumum. PLA - - - - - - - ' . . Ir. - - - - - - - - - - - - - - - - - - - I. L. L. - - . . . il - - . H. L. L. . . Lulu - - Hill - in - . - - -