Class Member Claim Form

South Carolina Exxon Mobil UST Class Action Claims Form

Mary Louise Fairey, et al v. The Exxon Corp., et al

C/A No.: 94-CP-38-118
This is a Court approved claims form for those claimants who are members of the class described below which must be filed with the Orangeburg County Clerk of Court’s Office not later than May 28, 2004 ("Bar Date"). Claim forms can be filed in person at 190 Gibson Street, Orangeburg, South Carolina or by mail at Post Office Drawer 9000, Orangeburg, South Carolina 29116.
Those persons who possess an interest in real property within the state of South Carolina that have been potentially contaminated by petroleum products, or chemicals associated with petroleum products that have leaked, spilled, or been released into the environment either from equipment owned, operated or controlled by Exxon, its agents or its predecessors, or for service station operations conducted by Exxon, its agents or predecessors, or under the control of Exxon or its predecessors.
If you are a member of the class described above, you are entitled to file a claim for recovery of damages to be paid from a fund created by the settlement of the referenced class action. The procedure to be followed to prove your entitlement to damages will be provided to you upon your timely completion and filing of this Claim Form. You may also have access to this claims procedure and this claim form for online completion at www.scexxonmobilustclassaction.com. Those claimants wishing to complete their Claim Form online must do so not later than May 21, 2004. Claim forms completed online will be filed by Class Counsel.
IF YOU ARE A MEMBER OF THIS CLASS, YOU MUST SUBMIT A CLAIM FORM BY THE BAR DATE SET FORTH ABOVE OR ANY CLAIM YOU HAVE AS A MEMBER OF THIS CLASS WILL NOT BE ALLOWED AND YOUR RIGHTS AGAINST EXXON ARISING OUT OF THIS ACTION WILL BE FOREVER BARRED. If you are uncertain about whether you are a member of this class, you should consult with your counsel or you may contact Class Counsel at the following address:

C. Alan Runyan

Marion C. Fairey, Jr.

Lee D. Cope

Speights & Runyan

200 Jackson Avenue East

PO Box 685

Hampton, South Carolina 29924

1-800-348-3805

www.speightsrunyan.com

exxonca@speightsrunyan.com

 
     
1.   List the following for each claimant(s):
   
Name:
Address:
Phone:
Email:
  (If property is owned by more than one individual or company, please list all owners)
     
2.   List the physical address of each property for which claimant(s) is/are making a claim:
   
     
3.   Identify the ownership interest claimant(s) has/have in the property listed in 2 above:
   
     
4.   Provide a brief statement of your basis to believe that the property listed in 2 above was/is contaminated from Exxon’s service station operations.
   
     
    Name of Claimant(s) or Claimant(s) Authorized Representative:
   
     
    Today's Date:
    -- mm/dd/yy