Certification of Valid Claim
The undersigned, as principals and as legal representatives of [insert owner or operator] and [insert name and address of third-party claimant], hereby certify that the claim of bodily injury [and/or] property damage caused by an accidental release arising from operating [owner's or operator's] underground storage tank should be paid in the amount of $[_____].
[Signatures]
Owner or Operator
Attorney for Owner or Operator
(Notary)
[Signature(s) ]
Claimant(s)
Attorney(s) for Claimant(s)
(Notary) Date
Mont. Admin. r. 17.56.824
75-11-505, MCA; IMP, 75-11-505, MCA;