Microsoft Office 2000 Professional Confirmation

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					 I7261MS
Settlement Administrator-Mississippi
P.O. Box 4153
Portland, OR 97208-4153


Company Name



Name



Address 1



Address 2



City                                                                                   State         Zip

 THE SETTLEMENT ADMINISTRATOR AND MICROSOFT RESERVE THE RIGHT TO AUDIT ANY AND ALL CLAIMS.
         PERSONS MAKING FALSE CLAIMS MAY BE SUBJECT TO CIVIL OR CRIMINAL PENALTIES.

                                      MICROSOFT MISSISSIPPI SETTLEMENT
                                      THIS IS THE VOLUME LICENSE CLAIM FORM
        If you reside in Mississippi and purchased a license for a Microsoft Operating System or Microsoft Application or a
personal computer that came with this software between January 1, 1996 and June 11, 2009, and did not purchase it for
resale, you may be eligible to file a claim. The State of Mississippi, State agencies and departments (including State
colleges and universities) are not eligible to submit a claim for vouchers under the settlement.
        If you licensed any software through the Microsoft Open, Select, School or Enterprise Agreement licensing plans,
use this form. This is the claim form for Volume licenses. If you have not purchased any software through Microsoft's
Volume licensing programs, use the Standard Claim Form instead.
        If your covered Microsoft product came pre-loaded on a computer, use "Part D - Other Purchases" on this form in
addition to Parts A, B, and C of this form.
       All covered Microsoft Products are listed in the Appendix to the Settlement Agreement. In general, they include all
Microsoft MS-DOS and Microsoft Windows versions sold during the Class Period and all Microsoft Word, Microsoft Excel,
and Microsoft Office versions sold during the Class Period and compatible with a Microsoft Operating System.
                                           INSTRUCTIONS TO VOLUME LICENSEES
        It is important to follow these instructions carefully. Otherwise, we may not be able to process your claim.
        In order to receive the benefits of this settlement, you must complete and mail this Claim Form with any requested
attachments to: Settlement Administrator, P.O. Box 4153, Portland, OR 97208-4153, postmarked on or before October 16,
2009. You must also redeem your voucher(s) by mailing them on or before the voucher expiration date that will be printed
on the voucher(s) you receive.
     IF YOU DO NOT RETURN THIS ENTIRE CLAIM FORM POSTMARKED BY THE DEADLINE, YOUR CLAIM
CANNOT BE PROCESSED AND YOU WILL NOT RECEIVE A REIMBURSEMENT FORM OR ANY VOUCHER(S). IF
YOU WANT TO REDEEM YOUR VOUCHER(S) AT THE SAME TIME YOU ARE MAKING THIS CLAIM YOU MUST ALSO
COMPLETE PART G OF THIS FORM.
                                             PART A - CLAIMANT INFORMATION
        PLEASE PRINT THE FOLLOWING INFORMATION RELATED TO YOUR MICROSOFT VOLUME LICENSE
AGREEMENT. (Please verify your name and address information at the top of page 1 and correct it if necessary in the box
provided.) ALL PERSONAL INFORMATION WILL BE KEPT CONFIDENTIAL.

         Tax ID Number:
         or Social Security Number:
         or a photocopy of your
         valid driver’s license:             (Check if attached)


         Phone Number:                 (            )                            x
         Email address (optional):

Form I7261MS
                                               Questions? Claim 877 page 1 of
                                             Volume LicenseCall 1 Form841 8160 6
                                              olume
 *I7262MS*
                                                 Volume License Claims
        For licenses obtained through the Open, Select, or Enterprise Agreement licensing plans, you can prove
your claim by attaching any of the following: license confirmations, enrollment forms, or printed records from
eOpen or MVLS. The attached proof must clearly indicate the date purchased and either the authorization number,
the license confirmation number or the enrollment number for each claimed license. To obtain license information
through eOpen and MVLS, read below.
        1. For volume licensing under the Open plan, go to https://eopen.microsoft.com
        In order to use the website listed above, you will need to use (or create) a Microsoft .NET Passport name
and password. If you don't have a Microsoft .NET Passport, select the "Sign in .NET" symbol and then the "Get
one now" link. In order to access information about the licenses you obtained under the Open volume licensing
plan, you will need to provide an authorization number and license confirmation number. When you order
volume products for the first time, your order is assigned an authorization number which is valid for two years.
You may have more than one authorization number.
        2. For volume licensing under the Select or Enterprise Agreement plans, go to https://licensing.microsoft.com
        In order to use the website listed above, you will need to use (or create) a Microsoft .NET Passport
name and password. If you don't have a Microsoft .NET Passport, select the "Sign in .NET" symbol and then the
"Get one now" link. In order to access information about the licenses you obtained under the Select and
Enterprise Agreement volume licensing plans, you will need to be an authorized user of your company's volume
licensing agreements. If you want to become an authorized user of your company's volume licensing agreements,
go to: https://licensing.microsoft.com and select the "Support" button for a list of email addresses and phone
numbers where you can request access to your company's volume license information.
       Each of the volume licensing websites listed above has a support menu that will assist you in setting up a
Microsoft .NET Passport account, remembering or changing your account password, finding your account
information, or any other site related question.
        Once you have become an authorized user of your company's volume license agreements, go to
http://www.microsoftproductssettlement.com/mississippi/volumelicensing.htm to obtain detailed instructions on how
to create the reports to attach to your claim. These reports must be in the correct format in order for your claim to
be processed.
        Check this box if you want Microsoft to search their volume licensing p g
                             y                                                  g program data for the necessaryy
                                            y                                                             y
license information to further document your claim. In order to access information about the licenses you obtained
                               p      g
under the Select and Enterprise Agreement volume licensing plans, you will need to be an authorized user of your
company's volume licensing agreements.
        If you licensed software during the period from January 1, 1996 through June 11, 2009 that was not covered by
a Volume license, fill out Part D - Other Purchases.

                                         PART B - OPEN LICENSE PROGRAM
         Open License Authorization Number(s):                                    Reseller Name:




                            PART C - SELECT AND ENTERPRISE LICENSE AGREEMENTS
         Select or Enterprise License Master Business Agreement (MBA) Number:

         Select or Enterprise License Agreement Number(s) (1 or more):




         Select or Enterprise License Enrollment Number(s) (1 or more):




                                             Questions? Call 1-877-841-8160
                                          Volume License Claim Form page 2 of 6
Form I7262MS
*I7263MS
                                               PART D - OTHER PURCHASES
 Many companies obtained licenses for Microsoft software that were not covered by a Volume license.
         y
 You may submit an OEM or SB invoice, shipping statement, or other equivalent document instead of completing
 the table below.
          1.      For licenses obtained preloaded on a computer, record the date you purchased the OEM or SB machines
                  that included the Microsoft product and then enter the number of copies purchased. If more than five
                  licenses were obtained, you must also provide the Product ID or Product Key number for the computers
                  purchased for all licenses beyond the first five claimed.
          2.
                  Any other licenses you obtained can be claimed here by completing the information for that license.
          3.
                  Make additional copies of this form if needed.
                          FINDING YOUR PROOF OF PURCHASE IDENTIFYING NUMBERS

 FOR OPERATING SYSTEMS (All eligible Windows and MS-DOS products):
          1.
                  For operating systems that came loaded on a computer you bought after June 1998, you can usually find
                  a Product Key number or Product ID number on a Certificate of Authenticity attached to the chassis of
                  your computer.
          2.
                  The Product Key number or Product ID number may sometimes be found on the Certificate of
                  Authenticity printed on your Operating System product manual.
          3.
                  You can often find the Product Key number on the CD case or sleeve that came with the software. The
                  Product Key number is on an orange sticker located on the CD case or sleeve.
          4.
             You can also find the Product ID number for Windows 95, Windows 98, Windows 98 Second Edition,
             Windows Millennium Edition, Windows 2000 and Windows 2000 Professional, and all versions of
             Windows NT Workstation (except version 1.0) by right-clicking on "My Computer" and then clicking on
             "Properties." Alternatively, you may click on "Start," then on "Control Panel" and then on "System."
 FOR APPLICATIONS (Office & Excel):
          1.
                  For products that came on a CD-ROM, there is often an orange sticker with a Product Key or CD Key
                  number on the CD case or sleeve.
          2.
                  The Product Key number or Product ID number may sometimes be found on the Certificate of
          3.      Authenticity printed on the product manual, or attached to the CD case or sleeve.
                  For all versions of Office, Word, Excel, or Works Suite the Product ID number can be found by opening
                  the specific application, clicking "Help," and clicking "About [application name]" (e.g. "About Microsoft
                  Word", etc.).
 FOR OLDER PRODUCTS, or FOR PRODUCTS NO LONGER IN USE ON YOUR COMPUTER:
          If you cannot find the CD case or sleeve for your product, you should look for the Certificate of Authenticity. Most
          Certificates of Authenticity have either a Product ID or Product Key number printed on them. You can use this
          number to document your purchase of that product. The Certificate of Authenticity can be found in three places:

          1.
                  Many Certificates of Authenticity for operating systems are attached to the computer chassis. Those
          2.      Certificates of Authenticity have a Product Key number or a Product ID number on them.
                  Many Certificates of Authenticity are part of the product manual. Sometimes the entire front cover of the
                  manual is the Certificate of Authenticity, and sometimes the Certificate of Authenticity is a large sticker on
                  the cover of the manual. Often these Certificates of Authenticity have a Product ID number or Product
                  Key number on them.
          3.
                  Some Certificates of Authenticity were located on the box the software product came in. These
                  Certificates of Authenticity generally do not have a number on them. If you cannot find a Product ID or
                  Product Key number on your Certificate of Authenticity, you can enclose the original Certificate of
                  Authenticity itself with this Claim Form to document your purchase.
          Additional information about Certificates of Authenticity, Product Key numbers, Product ID numbers, and CD Key
          numbers, including examples of them, is located on the web site:
          www.microsoftproductssettlement.com/mississippi.
                                             Questions? Call 1-877-841-8160
                                           Volume License Claim Form page 3 of 6
FormI7263MS
                                                                                              PART D - OTHER PURCHASES
                                                                                                                                                                                                              Check if
PLEASE PRINT THE FOLLOWING INFORMATION.                                                                                                                                                            Check if  documents
                                                                                               Product ID (PID) OR Product Key (PK) or CD Key (CDK)
 Product Purchased    Year      Number of                                          (Do not include dashes or spaces. If more than quantity of 1, supporting documentation must be submitted.)   PID or PK/CDK attached
(Please use the corresponding letter
   listed below, I.e. W, O, S or A.)   Purchased            Licenses Purchased
    1
                                                                                                                                                                                                                         *I7264MS




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                            Item Number
 Appendix              (enter a letter from this column                                                                      Product Title/Edition
                   in the Product Purchased field above.)
        A1                             W                    Windows 95, Windows 98, Windows 98 Second Edition, Windows Millennium Edition
                                                            Office, Office 95, Office 97, Office 2000, Office XP, Office Professional, Office 95 Professional, Office 97 Professional,
        A2                             O                    Office 2000 Professional, Office 2002 Professional, Office XP Professional, Office XP Professional Special Edition, Office 2000 Premium,
                                                            Office Small Business, Office 97 Small Business, Office 97.2 Small Business, Office 2000 Small Business, Office XP Small Business
        A3                             S                    MS-DOS, Windows, Windows for Workgroups, Windows 2000 Professional, Windows NT Workstation, Windows XP Home Edition,
                                                            Windows XP Professional
        A2                             A                    Word, Word 95, Word 97, Word 98, Word 2000, Word 2002, Excel, Excel 95, Excel 97, Excel 2000, Excel 2002, Home Essentials 97,
                                                            Home Essentials 98, Worksuite 99, Worksuite 2000, Worksuite 2001, Worksuite 2002
     Form I7264MS                                                                            Questions? Call 1-877-841-8160
                                                                                           Volume License Claim Form page 4 of 6
                                       PART E - CERTIFICATION UNDER PENALTY OF PERJURY
     *I7265MS*
      THE SETTLEMENT ADMINISTRATOR AND MICROSOFT RESERVE THE RIGHT TO AUDIT ANY AND ALL CLAIMS.
      PERSONS MAKING FALSE CLAIMS MAY BE SUBJECT TO CIVIL OR CRIMINAL PENALTIES. FRAUDULENT
      SUBMISSION OF MULTIPLE REQUESTS COULD RESULT IN FEDERAL PROSECUTION UNDER THE U.S. MAIL
      FRAUD STATUTES (18 U.S C. § 1341 AND 1342).
         I hereby declare under penalty of perjury that I am the person (or the spouse, or the parent of the dependent child or
 the authorized representative of the business, school or other entity) who purchased and paid for each and every one of the
 covered Microsoft products described in this claim form, that the product(s) were not returned or transferred to others, that no
 one else has made a claim regarding these products, that the products were purchased for use in Mississippi, and that all the
 information I have given on this claim form and the documents I have attached is true and correct.
          I expressly and irrevocably waive and fully, finally and forever settle and release all claims, demands, actions, suits
 and causes of action against Microsoft and/or its directors, officers, employees, attorneys, insurers or agents, whether known
 or unknown, asserted or unasserted, that I ever had, could have had, now have or hereafter can, shall or may have, relating in
 any way to any conduct, act or omission which was or could have been alleged in the Mississippi Action and which arise from
 or relate to the purchase, use and/or acquisition of a license for a Microsoft Operating System and/or Microsoft Application and
 where the claims, demands, actions, suits or causes of action concern or relate to any of the following: (a) antitrust (including
 without limitation the Sherman Antitrust Act, 15 U.S.C. § 1 et seq., and the Mississippi Antitrust Act, Miss. Code § 75-21-1 et
 seq.),(b) consumer protection (including without limitation, the Mississippi Consumer Protection Act, Miss. Code § 75-24-1 et
 seq.), (c) unfair competition, (d) unfair practices, (e) price discrimination, (f) trade regulation, (g) trade practices, and/or (h)
 other federal or state law, regulation or common law similar or analogous to any of the above. This Release does not include
 claims relating to Microsoft’s conduct, acts or omissions that take place after the Purchase Period but does include any and all
 claims described above relating to Microsoft’s conduct, acts or omissions that occured prior to the end of the Purchase Period.
         I understand and agree that to the extent I am an “Eligible Purchaser” as that term is defined in the Settlement
 Agreement, by submitting this Claim Form, I am expressly agreeing to the Release described in the paragraph above
 regardless of whether or not my claim is approved or whether or not I ultimately receive or redeem vouchers under this
 settlement and I hereby expressly acknowledge and agree that neither the rejection of my claim nor a failure to receive or
 redeem vouchers shall have any effect on the validity of the Release.
                    Company Name

                        Signature
        .
                        Title                                                                        Date
                                                                                                             MM        DD      Y Y Y Y

    Print your          First Name:                                                                                             MI:
    name here
                        Last Name:

                                     PART F - SUBSTITUTE FORM W-9 CERTIFICATION
You MUST ent er your taxpayer identification number below. For most individuals, this is your Social Security number. The
Internal Revenue Service requires such taxpayer identification number. This information will only be provided to the IRS as required
by law.


            Tax Identification Number (TIN)                                     Social Security Number (SSN):
Certification: Under the penalties of perjury, I certify that the tax identification number shown is true, correct and complete. I certify
that I am a U.S. citizen or a resident alien. I also certify that I am NOT subject to backup withholding.
Note : If you have been notified by the IRS that you are subject to backup withholding, strike out the word "NOT" in the Certification
above.
                                            DECLARATION UNDER PENALTY OF PERJURY:
            Claimant certifies that the information on this substitute form W-9 Certification is true, complete and correct.
   The Internal Revenue Service does not require your consent to any provision of this document other than the certifications
   required to avoid backup withholding.

       Claimant's or authorized
       individual's signature:

    Print your          First Name:                                                                                              MI:
    name here
                        Last Name:
                                                    Volume License Claim Form page 5 of 6
     Form I7265MS
                                                        PART G – REDEMPTION
       *I7266MS*             (Optional - Use only for combined Claim Form and Voucher Reimbursement)
You may redeem your approved voucher(s) for a cash rebate of some or all of the purchase price of Qualifying Hardware or
Qualifying Software. Qualifying Hardware includes new personal computers, laptop computers, Tablet PCs and Apple
Macintosh computers. If the total amount of your voucher(s) is less than $950, you may also redeem your voucher(s) for the
purchase of printers, monitors, scanners, keyboards, mice and other pointing devices. If the total amount of your voucher(s) is
equal to or more than $950, you may redeem your voucher(s) for the purchase of printers, monitors, scanners, keyboards,
mice and other pointing devices only in connection with the purchase of a computer. You cannot redeem vouchers for rebates
on the purchase of PDAs or other hand-held devices, server hardware, or other personal computer peripherals or
components purchased seperately from and not intergrated into the Qualifying Hardware described above. Qualifying Software
is the client or stand-alone version of software sold by any company that runs on personal computers, laptop computers,
Tablet PCs and Apple Macintosh computers, but does not include server software, custom software or consulting services.
You can redeem your voucher(s) for a rebate for one or more properly documented Qualifying Hardware or Qualifying
Software purchase made after June 11, 2009, up to the total amount of the voucher(s). You cannot redeem a voucher for a
rebate on any local or state sales tax or other tax on the purchase of other Qualifying Hardware or Qualifying Software.
Microsoft will not provide rebates in excess of the amount of approved voucher(s).
You must redeem your voucher(s) by mailing them on or before the voucher expiration date that will be printed on the
voucher(s) you receive.
For each purchase that you are submitting with this form, you must include a photocopy of the sales receipt showing the
date and the amount of the purchase, and the original of the UPC bar code or other proof-of-purchase symbol from the
product package. REIMBURSEMENT REQUESTS CANNOT BE PROCESSED WITHOUT THE RECEIPT AND UPC OR
OTHER PROOF-OF PURCHASE SYMBOL.


 Item     Hardware or Software             Description (PC, Scanner, Accounting Program, etc.)                   Price


   1                                                                                                                     .
   2                                                                                                                     .

   3                                                                                                                     .

   4                                                                                                                     .

   5                                                                                                                     .

                                                REIMBURSEMENT CERTIFICATION

I hereby declare under penalty of perjury that I/this Company purchased and paid for each and every one of the products described
in this reimbursement form, that the products were not returned or resold and that all of the information I have given on this
reimbursement form is true and correct.

                  Company Name

                    Signature




                     Title                                                                  Date
                                                                                                   MM       DD       Y Y Y Y

   Print your name here

                    First Name:                                                                                          MI:


                    Last Name:



                                                  Questions? Call 1-877841-8160
                                                Volume License Claim Form page 6 of 6
   Form I7266MS

				
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Description: Microsoft Office 2000 Professional Confirmation document sample