IMPORTANT -- All unclaimed property Class Members who attest that they suffered economic harm will automatically receive a minimum Base Payment as provided for in the unclaimed property Agreement. In addition, you may be eligible to receive compensation for economic losses above the Base Payment amount if you can prove (as described below) greater economic losses.
If you wish to be paid from the unclaimed property, you must complete and submit this Claim Form. This Claim Form is for unclaimed property Class Members who suffered economic harm in connection with the release of chemicals from the Altuglas chemical plant in Bristol, Pennsylvania into the Delaware River in March 2023, or because of the public notice and drinking water advisories issued in connection with that release. By completing this form, you are attesting that you suffered an economic loss (such as the purchase of bottled water, transportation costs, or business interruption losses) as a result of the release of chemicals from the Altuglas chemical plant in Bristol, Pennsylvania into the Delaware River in March 2023, or because of the public notice and drinking water advisories issued in connection with that release.
If you fill out and submit this Claim Form, you must answer all questions honestly and accurately. You are swearing under penalty of perjury that your statements below are true and correct just as if you were testifying in court. If you do not claim to have suffered economic harm as a result of the release of chemicals from the Altuglas chemical plant in Bristol, Pennsylvania into the Delaware River in March 2023, or because of the public notice and drinking water advisories issued in connection with that release, you should not fill out this Claim Form.
Each Eligible Claimant who completes and submits this Claim Form will be distributed a Base Payment amount. To receive the applicable Base Payment, you must complete I, III, IV, and V of this Claim Form. If you suffered additional costs and losses above the automatic Base Payment amount, and have proof of such economic losses, you must also complete Part II of this Claim Form and submit additional supporting documentation in order to be eligible to receive compensation above the Base Payment amount.
To complete this Claim Form and receive a Base Payment you must:
- completely fill out Part I -- Claimant Information;
- attach documentation proof that you lived in the Impacted Area in Part III – Upload Supporting Documentation;
- select a payment option in Part IV – Payment Selection;
- personally sign the Attestation, Certification and Declaration in Part V;
- return your completed Claim Form and any requested documentation to the unclaimed property Administrator by mail or by this Website.
If you suffered economic losses above the Base Payment amount and are requesting additional compensation, you must also:
- completely fill out Part II -- Financial Harm and attach all documentation of your alleged harm as requested below.
YOU MUST SUBMIT YOUR COMPLETED CLAIM FORM BY JULY 17, 2024 FOR IT TO BE CONSIDERED TIMELY.
If you have any questions about this Claim Form, please call the unclaimed property Administrator toll-free at 1-888-605-0772 or contact the unclaimed property Administrator using the Contact Us form.