ClaimFormNoAuto-Owners (Mutual) Insurance Company, Case No. No. 2023-LA-0000143 Circuit Court for Peoria County, Illinois SUBMIT BY FEBRUARY 26, 2024 OR MAIL TO: Walker v Auto-Ownersc/o Atticus AdministrationPO Box 64053St. Paul, MN 55164Email: aodepreciationsettlement@atticusadmin.comClaimant InformationInsured Name Business Name Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Current Phone Number*Current Email Address* Claimant ID* Upload your Claim Form here*Accepted file types: pdf, jpg, jpeg, bmp, png, docx, doc, xlsx, xls, Max. file size: 16 MB.If you have more than one document to attach, please submit your documentation via email at: aodepreciationsettlement@atticusadmin.com.Typed Signature Name* CAPTCHAUnique IDPhoneThis field is for validation purposes and should be left unchanged.
