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- <br /> r <br /> STATE USE ONLY <br /> � <br /> JOINT CLAIMANT <br /> IDENTIFICATION FORM <br /> Fill out this Section only ifthere isoJoint Claimant to be named on this claim. Where multiple owners and operators have <br /> ' <br /> incurred or are responsible for different costs at the same site, they can be identified as Joint Claimants. Aspouse}enot <br /> normally considered Joint Claimant <br /> RA <br /> WHEN A JOINT CLAIM IS SUBMITTED,THE CLAIM IS BASED ON THE LOWEST PRIORITY APPROP,7t NY JOINT CLAIMANT. <br /> LIST EACH JOINT CLAIMANT AND THEIR APPROPRIATE PRIORITY CLASS: <br /> A. "NT CLAIMANT UWE C.JOINTCLA4] ANTISFIUNGAS�: <br /> "T CL ,N OPERATOR OF TANKM <br /> ER OF TAANK(S) <br /> MAILING ADDRESS 7ANDETS THE REQUIREMENTS FOR PRORMY CLASS: <br /> TELEPHONE NUMBER B. TAX IDENTIFICATION NO. OWNERSHIP/OPERATION <br /> FROm: TO: <br /> A. jol IT CLAIMANT NAME C.JOINT CLAIMANT IS FILING AS: <br /> 71 OWNER OF TANK(S) F7 OPERATOR OF TANKM <br /> MAILING ADDRESS AND MEETS THE REQUIREMENTS FOR PRIOR17YCLASS: <br /> ;4 0. DATES OF OWNERS H1 P/OPERA71ON <br /> TELEPHONE NUMBER B. TAX 1DEN71F1C7AN NO. FROM: TO: <br /> Fill out this Section only if a Co—Payee is t be named on this claim. Owners and operators can designate a representative <br /> ee is t be name( <br /> who has advanced funds for cleanup as Co—Payee. The Co—Payee will be named on the payment Representatives are <br /> i s to S. —Payee and the <br /> usually insurance companies and lendi i/institutons. A copy of the financial agreement between the Co <br /> claimant is to be submitted with this cl im. <br /> A. co-PAYEE NAMI�EL <br /> MAILING ADDRESS <br /> ZJP CODE <br /> CITY STATE <br /> TELEPHONE NO. B. ID FICATION NO, <br /> eEVISED 1$964) (SEE FACING PAGE FOR INSTRUCTIONS) <br /> ! <br />