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day, Mar 21, 2017 11:55 AM
Exemption year: ANT
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date 't Q t ell12- 1 2-D1 1
Applicant's Name: CNl°►.'le,i_;lo1k Telephone No.
Billing Address:
Address of Exemption:
J-6Cver f t") (� � oto s az!
Garai 1 ev[rr) OEO''a
Water Works Account No.: IVA qa r1L. 1
I request an exemption from Garbage Fees during the current Calendar Year. I
employ the services of a licensed trash haule Only the-- •ca ion where the;
l4;6r mption.
trash hauler picks up garbage and tras. w
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TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) ( Ex) vc (1c,,Vkc- 4 -1 ---
Company Name
a licensed trash. hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
hereby declare that we are
Customer's Name
• Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
c- 51.4- 6c-uouxL1-tu-5
k 17 14(3W?
CONTRACT PERIOD MUST COVER al 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 291-4323.
.313o CZ
Date Signature of Authorized Company Representative
Company's Address
_(c
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
Exemption year: 2V "
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date (2-12- c
Applicant's Name:
Billing Address:
ASeetlC.hlakTelephone No.25?)-(
2211 flicLoocuid Ave r 0 (0U,1A w76 I
Address of Exemption:
Water Works Account No.: tb (os-2)C..(6c-OCi3/47
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.
ctori w 4 7j(Jur/t-lKd
pp icant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
�l►�� , ewi con rasnia
Company Name
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:
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
kkcLn6kon Lean. Un. Z11 t' mato. / wloo pip* ra r)
CONTRACT PERIOD MUST COVER AT LEAST CUURRE\T 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 291-4323.
`a.L V7 ` cce
Date LL
Signature of Authorize. Company Representative
QI RC s6�r., L'S 100, -a 5070a
b�
CAL w4 £lacthak .. ritUcil
Gar age & Tra 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