This Claim Form is for residents of St. Croix whose current residence was impacted by a release from the Limetree Bay Facility on February 4, 2021 or May 12, 2021 (the “Release Events”) and who believe they satisfy the following requirements to participate in the Court-ordered Limetree Water Distribution Program (the “Water Program”). Each Eligible Resident is entitled to up to twelve (12) gallons of water per day per household, with a maximum amount per household of eighty-four (84) gallons of water per week. To participate in the Water Program, you must complete and submit this Claim Form along with supporting documentation.
You must attest AND support that you currently reside in one of the following estates (the “Covered Area”): Adventure, Betty’s Hope, Cane, Cain Carlton, Campo Rico, Carlton 1 North, Carlton 1 South, Carlton 2, Clifton Hill, Concordia, Diamond, Enfield Green, Envy, Frederiksted, Golden Grove, Good Hope, Hannah’s Rest, Hesselberg, Hogensborg, La Grange, Mannings Bay, Mount Pleasant, Negro Bay, Paradise, Ruans Bay, Sandy Point, Smithfield, Stony Ground, Two Brothers, Upper Bethlehem, Wheel of Fortune/Mars Hill, Whim, Whites Bay, Whites Bay 2, and Williams Delight; AND
You must attest that your current residence actively uses or used cistern water; AND
You must attest that you have a belief that your current residence was impacted by a Release Event; AND
You must attest and support that you meet certain criteria showing you cannot afford to purchase water without trading off other basic necessities (“Financial Hardship”).
IMPORTANT: To be accepted, your Claim Form must be completed, signed, and dated. If your Claim Form is incomplete, unsigned, or contains inaccurate information, it will be rejected, and you will need to resubmit your Claim Form. Note, however, that your Claim Form may be signed via electronic signature.
The requirements must be satisfied by any adult applicant to participate in the Water Program, and if the requirements are satisfied as to any adult, then they are also deemed to have been satisfied by all other members of that person’s household residing at the same address (i.e., if an Applicant qualifies, then the household qualifies). For this reason, this Claim Form requests that the Applicant list all members of his or her household.