HomeMy WebLinkAboutX Y Z - 2016 Private HaulerExemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
0/5
Applicant's Name:
Billing Address:
Address of Exemption:
Telephone No.
/ gve
2ILLKIm h41/
eiu,e
Water Works Account No.: g- 1- ()6/0
I request an exemption from Garbage Fees during the current Calendar Year.
employ the services of a licensed trash hauler. Only the location where the..
trash hauler picks up garbage and trash wi I qualify for the exemption.
p licant s Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
hereby declare that we are
a licensed trash hauler in. the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
Customer's Name
Address Location of
Garbage/Tra_sh atc12,2UR
1 /
14\2'
Beginning
Date of
Contrag_t
Ending
Date of
Contract
CONTRACT PERIOD MUST COVER AT. LEAST. CURRENT CALENDAR YEAR
We understand that the above information is used by the Clerk's Office in
Waterloo, City Hall, 715 Mulberry Street, to determine eligibility for
exemption from garbage fees for the current calendar year. I, the
undersigned, declare under penalty of perjury that I have examined this
claim, including all statements and above schedule, and to the best of my
knowledge and belief, it is a TRUE, CORRECT AND COMPLETE claim, and that I
agree to comply with all ordinances and policies of the City of Waterloo and
the Black Hawk County Solid Waste Commission.
In the event that the above person discontinues service with said company
during the current calendar year, we hereby agree to notify the Clerk's
Office of this event by calling 29124323.
11—
Date
Signature of Authorized Company Representative
Pi(
Company's Addres
Garbage & Trash Hauler's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
City Clerk's Copy - white Customer's Copy - yellow
EKemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
PESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:27/ r
Billing Address:
Address of Exemption:
17/2
Water Works Account No.:
Telephone No.,6--Z9,64-5
-- )1
I request an exemption from Garbage Fees during the current Calendar Year. I
employ the services of a licensed trash hauler. Only the location where the
trash hauler picks up garbage and trash will qualify for the exemption.
Ar7,eQi LL4i-'
Applicant's Signature
TO BE COMP ETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
Company Nam6
hereby declare that we are
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
Customer's
ON /14
Address Location of
Garbage/Trash Pi k -U
• Beginning Ending
Date of Date of
;Q271:trat. Contract
J-771; I/0 6/6
CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR
We understand that the above information is used by the Clerk's Office in
Waterloo, City Hall, 715 Mulberry Street, to determine eligibility for
exemption from garbage fees for the current calendar year. I, the
undersigned, declare under penalty of perjury that I have examined this
claim, including all statements and above schedule, and to the best of my
knowledge and belief, it is a TRUE, CORRECT AND COMPLETE claim, and that I
agree to comply with all ordinances and policies of the City of Waterloo and
the Black Hawk County Solid Waste Commission.
In the event that the above person discontinues service with said
during the current calendar year, we hereby agree to notify the
Office of this event by calling 291-323
Date
company
Clerk's
Signature of Authorized Company Representative
Compan,
's Address
Garbage & Trash Hauler's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
City Clerk's Copy - white Customer's Copy - yellow
xempti o n year //
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
PESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
plc-) LeZ
Applicant's Name
Billing Address:
Address of Exemption:
Water Works Account No.:
elephone No.
„:///
1 79&‘5 /7 7M
I request an exemption from Garbage Fees during the current Calendar Year. I
employ the services of a licensed trash hauler. Only the location where the
trash hauler picks up garbage and trash will qualify for the exemption.
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) VA ‘oo&A--\:Uotq-eSs hereby declare that we are
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
Beginning Ending
Address Location of Date of Date of
Customer's nmg. Garba e Trash Pick -4 oitrt Coqtract
C tt'm ( C ,
CONTRACT PERIOD MUST COVER AT LEAST. CURRENT CALENDAR YEAR
? 7)
We understand that the above information is used by the Clerk's Office in
Waterloo, City Hall, 715 Mulberry Street, to determine eligibility for
exemption from garbage fees for the current calendar year. I, the
undersigned, declare under penalty of perjury that 1 have examined this
claim, including all statements and above schedule, and to the best of my
knowledge and belief, it is a TRUE, CORRECT AND COMPLETE claim, and that 1
agree to comply with all ordinances and policies of the City of Waterloo and
the Black Hawk County Solid Waste Commission.
In the event that the above person discontinues service with said company
during the current calendar year, we hereby agree to notify the Clerk's
Office of this event by calling 291-4323.
Date
Si<jnatare of Aut orized Company Representative
Company' s Address
Garbage & Trash Ha 's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
City Clerk's Copy - white Customer's Copy - yellow