POST-DISTRIBUTION ACCOUNTING FORM
Hon. Josephine L. Staton
This form has been adapted from the Northern District of California's Post-
Distribution Accounting Form, and differs from that form in certain respects.
Please review it carefully.
Case Number (YY-xx-#####)
Case Name
Attorney Name
Nature of Action
Attorney Email
Party Represented
This is: An interim post-distribution accounting.
Not all settlement funds have been distributed.
_ A final post-distribution accounting.
All settlement funds have been distributed.
1. Total settlement fund $
2. Number of class members #
3. Number of class members to whom notice was #
successfully delivered*
4. Number of claim forms submitted # N/A
5. Percentage of claim forms submitted [=Q4/Q3] % N/A
6. Number of opt-outs #
7. Percentage of opt-outs [=Q6/Q3] %
8. Number of objections #
9. Percentage of objections [=Q8/Q3] %
10. Average recovery per claimant $
11. Median recovery per claimant $
12. Maximum recovery per claimant $
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*Notice is successfully delivered when it is not returned as undeliverable.
13. Minimum recovery per claimant $
14. Methods of notice to class members [1 or more], and percentage of success by method if known.
Leave percentage blank if not known.
% Mail % Email % Text
% Advertisement % Website % Other
15. Methods of payment to class members [1 or more], and percentage of success by method if
known. Leave percentage blank if not known.
% Direct Deposit % Gift Card % Paper Check
% Wire % Payment App % Other
16. Number of checks not cashed in initial distribution #
17. Total value of checks not cashed in initial distribution $
18. Amount of settlement funds claimed by class member $ N/A
19. Amount of settlement funds distributed to class $
members
20. Ho w m a ny rounds of check
distribution occurred?
Name Amount
21. Amounts to be distributed 1. $
to each cy pres recipient
2. $
3. $
4. $
22. Administrative costs $
23. Attorneys’ fees $
24. Attorneys’ costs excluding expert costs $
25. Expert costs $
26. Attorneys’ fees in terms of percentage of the %
settlement fund
27. Plaintiffs’ counsel’s final lodestar total $
28. Lodestar multiplier [# x.y] # x.y
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29. Describe any potential fraud issues encountered, the likely causes, and how they were
addressed
30. Number of class members availing themselves of #
nonmonetary relief
31. Aggregate value redeemed $
Continued on next page.
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32. Where injunctive and or other non-monetary relief has been obtained, discuss the benefit
conferred on the class.
33. Other notes and issues required to be addressed pursuant to any Order in this case.
End of form.
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