HomeMy WebLinkAboutCExemption year: a017
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 1 Z - `- / (p
t
Applicant's Name: f1Lli7+&pJjST 6ftr.( ephone No.31q--333-O%3 )
Billing Address: ,QDC S• Wf1T- flOa-SE_ P/« /41c 0 o BDAi/ AA) ogJ0 ,
Address of Exemption: CAW £ L(,2TD/(% 4 L/ LJttra n -_o5 J / ,45D70.3
Water Works Account No.: 117A051-5/ (o 0-515
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 e mption.
Apr icant's Signature
TO BE COMPLETED BY er.)),,rir
LICENSED GARBAGE AND TRASH HAULER:
61Je_onirwi"QIi
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
Customer'sName
rzitvaiy fxtQ i4 C uLh
Address Location of
Garbage/Trash Pick -Up
Beginning Ending
Date of Date of
Contract Contract
qij raiN _ova
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.
I2 1
Date
q5 Ue
Signature of Authorized Company Representative
Q(.1E) -18(6 51-. M1000, =51- cd0
Company's Address
Cin i2 b\ANAA Cain hJ
Garbage & Tr sh Hauler's Permit Licen�e
(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:
al%
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
Address
t t- ( U G/ /
�n ri5 I� C 1uf Telephone No.,3j9�23�f-10-2.3/
34.75 Watr/uo 5070)--
3,/7<k;m !(.4v'e- Woce/lv5070)
14 -6O -5-27L1-0,24/3
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 cualify for the exemption.
Appl /ant 6¢naturd
gAd
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
Co
any Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Customer's Name
Address Location of
Garbage/Trash Pick -Up
hereby declare that we are
Iowa, and that we pick up
Beginning Ending
Date of Date of
Contract Contract
P/—c26/7 /.2-31-(207
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
during
Office
event that the above person discontinues service with said company
the current calendar year, we hereby agree to notify the Clerk's
of this event by calling 291-4323.
12- /9-49 1e,
Date Signature of Authorized Company Representative
Company's Address
vO
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: (21d f
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /
Applicant's Name :(T -() (C[ (2E)(711;11F Telephone NcC51-04,132 75I?
( �% 1� 5 577
Billing Address:
Address of Exemption: ////q
4710_,A-k cis 5 / t
Water Works Account No.: /C J4' - 5—C /✓ `7 7
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 ) i --' \1:1C\C- 4MOV___,t) Ste
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
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
DOU0 t cl C h; \ Lc z -1 I Ed.wa S -11
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.
f�!te "
Sire o Auth
ed Company Representative
Company's Address
As-u.Q
Garbage & Trash Hau er'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: �V
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name a -f9 r
Billing Address:
9
Address of Exemption:
Water Works Account No.
9
fle, ��j i �(� Q �/� TelephonesL ' �N — �J �fz�
/9-it)tA eiv, _S z__
z7/ w l
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.
plts Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) !31.O f ( 4cukkA.0aSte,
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
• Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
901 ,Av��}-vncmr.,1l—I-11
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 deteLmine 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.
‘--k re)(
Date S ature of u orized Company Representative
((i;\\ )za.0(4)0Nm
Company'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
Exemption year: :6 1
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
-E-
Applicant's Name: Telephone 34 SI
Billing Address:
Address of Exemption:
7 3 /irk= v/vrm/ 5 7-k4•4---7-
Water
iZ�z-r
Water Works Account No.: J/J `7 5 B " SG'30a S
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 BYYy� L1I/CENJS%EEDj A GAGE AND RASH HAULER:
(We) bfr t_f i 1C idac 4orCom an N
Company
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
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
Cf\i Alovivr H-17- /Z-3 FR -
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 callin•, 291-4323.
Datena ure of orized Company Representative
SI)
Compan
.QU✓kvr\
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
Exemption year: aC) 17
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date SL i y 3 J Q) 7
Applicant's Name: (11-1/ rrl ma.yri ' ---4):167. Telephone No . a 3 b - 9076
Billing Address:
Address
of Exemption: 8c3 a,rd 811 5r q DR, y-1cc, Sa
0
G
Water Works Account No.: ) - 3S - S16 Lvr(-, Gr, d ) dno 3' — 16 KS
I request
employ the
trash hauler
an exemption from Garbage Fees during the current Calendar Year. I
services of a licensed trash hauler. Only the location where the
picks up garbage and trash will qualify for the exemption.
TO BE ,�CO,MPLETED BY LICENSED GARBAGE AND (TRASH HAULER:
(We) I71U1,1�. -C,t.J( VJCt Q Oi �5�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
Address Location of
Customer's Name Garbage/Trash Pick -Up
C L t+ Mc"r. .Ifi
Beginning Ending
Date of Date of
Contract Contract
12-31-1-7
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 291-432.3.
Dat
Signature of A
horizea Company Representative
(-1;S\A bQ-0\0C)(.3\0C\
Company'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
Exemption year: (
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date 1 } 1 -)
Applicant's Name: (-\' ,( 1 r— ,-n qj; Telephone No.31q. 133-taa
Billing Address: 5 a -a - (\tcify.h
Address of Exemption:
Water Works Account No.: ` 1/C) - 2,2*Z2 - 0 66 ( /
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' Si nature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
61aC.- 14c- �s
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
1LA) )° t-(-17 1 31,1i
C k)' eh'4 CSAwz1A S gn
CONTRACT PERIOD MUST COVER az 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 callin^ 291-4323.
tow
1--(5-/
Date '�•na re of Authized Company Representative
X 6 I
Company's
-ecsic607-
(
C�IfV L
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
G
W
Exemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
HI
%
Applicant's Name: A,a Telephone No.
u,
Billing Address:,, , ,�fn,
Address of Exemption:
Water Works Account No.: 22.2;2._ KJ O / /-
I request an exemption from Garbage Fees during the current Calendar Year. 1
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.,
' i ;
i
:� ../,.--7.7r,,/_/ L.( :,.' --�.
Applicant's Signature /
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
it p
I. 1 1 i a 6'_..
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
Address Location of
Customer's Name Garbage/Trash Pick -Up
v
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 calendar year, we hereby agree to notify the Clerk's
Office of this event by calling 291-4323.
/
Date
SIgnatbre`of Autharized Company Representative
j
Company'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
fd
V
cxTh
Exemption year: '-D (7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA i
Date —: --11
0
Applicant's Name: maipc Cori (,u� Telephone
Billing Address:
5'a mcPr,ari s -t L.Q1erloo
No.311;i_So 3++
Address of Exemption: a -f3 (IGPC;C? i 5't t, q1 ftooz,4
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.
MOM* arumA442,1
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) ? \ cLCX ANIY4
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Address Location of
Customer's Name Garbage/Trash Pick -Up
Cor►)wPll cg -s? CIdi;0rtri St
hereby declare that we are
Iowa, and that we pick up
Beginning
Date of
Contract
Ending
Date of
Contract
(a-3(-1,7
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.
' A-11
Date
e oml
Signature of Aut oriz pang Representative
{bbY71
Company s Address
Garbage & Trash .a -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