HomeMy WebLinkAboutBExemption year: c-7 Orl
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date It31 n
Applicant's Name: Q Sy' � � ,-u Telephone No .3,01) -1469 -t4Ct
Billing Address:
_A 14 rl n(°_1,r) �t . . 6r 1b
Address of Exemption:
Water Works Account No.:
-ti
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) taLL ` `L4 . WCLk
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:
Customer's Name
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
iNtAl
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 ca 291-4323.
1 13y1
Date
Si'ature of Au horized Company Representative
Company's AddressN-Ir\
Garbage & Trash Hau =r'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
0
Exemption year: 0// 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name: Telephone No_aV3S4c/.j1Y7
,50 coy Ave_ bb 764 , 5(-) �� 3
Address of Exemption: Cis (��� fie.
Billing Address:
Water Works Account No.: 33"/ 5-/55 -o.g-5,D e,
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.
(QJQ
Applicant's Signature
TO BE COMPLETED BY LICENSED
GARBAGE �ANDTRASH HAULER:
(We) )3hk A sf� D)SAj&An -�A-4e' _
Company Nam
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/Trash Pick -Up
Beginning Ending
Date of Date of
Contract Contract
1-/-6r7 / /2--3/—17
CONTRACT PERIOD MUST COVER I. 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.
a7 "
Date Signature of Aut orize oNcIL2)
mpany Representative
Company's Address
Garbage & Traser's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
City Clerk's Cony - white Customer's Copy - yellow
Exemption year: 01
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date n l [f i l?r Mi
Applicant's Name: V\T
) vnril
Billing Address: M \c(ll)1 l f t\ Nit
Address of Exemption: B119 Nrioi) /\(t W r
1D5Th51I 011
Water Works Account No.:
V\.
1-1
Telephone No.
iDu-
x-131-083
1,100 (1101
irnoo 1A %111,11
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.
wcorm �. vranni
A plp icant' Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
\OL 4CW3C WQQ
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
S2(0 6\61:1 NyeH 1).-31-17
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 cal lig 291-4323.
ze Company
Date
Si n tare o Au 'ori Representative
� P Y
Comp y s Add
Garbage & Trass'auler'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: 6 1
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 2-8-
Applicant's Name: tE71/41J10,-. 7613,-- rQ^' 3 2 elephone No.319 Z3z-411l
Billing Address: I2-/ co Glenny Ave_, V%'Loo ,Th 56702_
Address of Exemption: I2./(0 G-,np hvc. 1NPLDOLa. 8070L
Water Works Account No.: j2 j L12g— 5 6I4.
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) �IMj e KAIf}(EiflF-AC 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 Name Garbage/Trash Pick -Up Contract Contract
Deik- v'. J&bny ilk 4 12-143 Gknti/ — l -.2 07 I2--3I-2A/7
wtLOG zta 707-
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 291-4323.
Date ,p'ignature of Aurized Company Representative
//60 /a f2 s' /ust S4 der Cie .�Ge
Company's Address
0, qt,
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
cx1
Exemption year:_ % 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date
Applicant's Name: (1) e c).. 1 rj
Billing Address:
Address of Exemption:
0
Vlsk
1:=51-t-x,hd ho rc-r- Telephone No :1 j,9' J39 y- ko,j,
L LA? S h J;s PA C. rc .543 0
(.9 e. e ,r cl e, n CQ_ A ve. LA.9c d'C), M
Water Works Account No.:
(-,rJ 674--5003 3 ,5" 07o-70')oa
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, )i-,7
trash hauler picks up garbage and trash will qualify for the exemption.
-
Q, Ery
Applicantis Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) �l LIL 44O\W14191(-. hereby declare that we are
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick u
garbage and refuse at the following location:
Customer's Name
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
bu \ d y cl i V Y 2 Seto 1 YAd , dkv, c- Zvi- 1- \ -n
CONTRACT PERIOD MUST COVER Ai LEAST CURRENT CALENDAR YEAR
1 ti-31-i-�
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.
Da
i te° Q I °1 j Mo
ignature of horied Company Representative
53 D.eAvbb'v . 4 NirolDb Ili ST) 03
Company's Address
i1
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
PRIVATE
Exemption year: 4.014 -
HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date IJJ1~1q-
Applicant's Name:
Billing Address:loiu altar 10-frritc,
8014- S'I i +KJI i 13nUAWaphone No0 -232 -22
NM) y l) U}afl?er ?1. L1JiWY)a),50q-03
100V0-- S.0051
Address of Exemption:
Water Works Account No.:
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.
Ap.
icant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(it ode
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
(We)
hereby declare that we are
Beginning
Address Location of Date of
Customer's Name Garbage/Trash Pick -Up Contract
Su* "San
N6 toc,l lis- 1-
Ending
Date of
Contract
la -3I - (i
CONTRACT PERIOD MUST COVER AI 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 calli..• 291-4323.
Ir
I-31-("7 Ig#
Date .gnature of e. thorized Company Representative
11 .e.AbO(V. Asa l,3 -(e -r104
Company's Address 1
x� szn 6 3
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
Baca,'
Rar3ch Cheese BaS4 - Cenas,.ess Deas
Applicant's Name:
Billing Address:
44,1 s u.5 -�C�e Y pn Telephone No. 3i9- aqL ^a��
`J�a i'ra k /2G1�c -e r�o n �buJG
Address of Exemption: 54 a j- p u �f
Water Works Account No.: / S - 5- - y 9 5 0 35'4 5 9
y
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'ignature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 17) '-- r) L r a i
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
Address Location of
Garbage/Trash Pick -Up
ic Poi
Beginning Ending
Date of Date of
Contract 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 calend year, we hereb agree to notify the Clerk's
Office of this event by ca li g 291-4323
Date Signature o Authoriz
Company's Address
Company Representative
a
—a0.ry150 LOLk) es-
r_ar},arra brach Uaill ar' c 73arm4i- T.i,.=rata
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