REQUEST FOR EXCLUSION FORM

I wish to opt out of the Settlement in Columbia Debt Recovery, LLC, v. Jordan Pierce and Donte Gardiner, and Gustavo

Cortez, Towana Peltier and Darius Mosely v. Columbia Debt Recovery, LLC, and Jordan Pierce et al., v. Thrive

Communities Management, LLC and Belkorp Holdings, Inc., Superior Court of the State of Washington County of King,

Case No. 20-2-16403-8 SEA

I understand that by submitting this form I will not receive any money or benefits from the Settlement, I will not be bound

by the Settlement, and I will not have any right to object, appeal, or comment on the Settlement.

Full Name

Telephone Number

Current Address

This Exclusion Form must be mailed, faxed, or e-mailed no later than January 23, 2024, to the Settlement Administrator

below to be considered timely:

Columbia Debt Recovery, LLC, v. Pierce and Gardiner et al.

c/o CPT Group, Inc.