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Application Forms

The following forms are included with the application and may be submitted as needed.   These documents are in ".doc" format so that you can save them directly to your computer and use them via your word processing software.  

Effective September 1, 2007, please begin using the Reimbursement Application - Original (2008) or Supplemental Reimbursement Application - Short Form S (2008).

Previous versions of the application that included the "bilateral agreement" and "special provisions" clauses are no longer applicable.  Applications submitted to the Fund using these old applications and contracts will not be accepted after September 1, 2007.

 Please see our notice under "What's New" for more information.

• Reimbursement Application - Original (2009) (Excel)
   
• Supplemental Reimbursement Application - Short Form S (2008) (Excel)
   
• Reimbursement Application - Original (2009) (Word)
   
• Supplemental Reimbursement Application - Short Form S (2008) (Word)
   
• Affidavit: Proof of Payment
   
• CPA Certification: Proof of Payment
   
• Affidavit: Work Performed by Applicant
   
• Affidavit: Work Performed By Listed Applicant
   
• Request to Transfer Fund Eligibility
   
• Affidavit: Lender
   
• Affidavit: Current - Former Property Owner
   
• Affidavit Property Owner - Mergers or Acquisitions
   
• Affidavit: Property Owner with Inherited Property
   
• Affidavit: Orphan or Abandoned Tanks (when property owner or tank owner with no responsibility for release)
   
• Affidavit:  Orphan or Abandoned Tanks - Mergers or Acquisitions (when property owner or tank owner with no responsibility for release)
   
• Affidavit: Tank Owner/Operator (tank owner/operator with no responsibility for release from operative tanks)
   
• Affidavit: Emergency Generator Tanks
   
• Affidavit: Waiver of $10,000 Deductible
   
• Affidavit: Waiver of Policy #8
   
• Protest of Fund Payment Report
   
• Listing of Costs (Excel)
   
• Client notification form MHN   (download for use in word processing software) 
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Please read over each of the instruction/information forms carefully and thoroughly before assembling your application. If you have any questions, our staff is more than happy to provide assistance: