HomeMy WebLinkAboutFExemption year: 0L Q f 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date
Applicant's Name: jro/1N /A. F /_ I_ L_ E R Telephone No .1% -- 9 7'
Billing Address:
3//, e s"i i i DTe. IVO r'; IA 5 G 7i 2 -
Address of Exemption: 5,2714e...
Water Works Account No.: /92:3 --?‘16,—.5-i.3
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.
Go-Aa/n' Tl , 7
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) $\ac,1C. \ 1('iLi (i,1JO&Q E I 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
Sohn
Gam. H -n
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.
Date Signature o uthorrzed Company Representative
\ Ncuron(A.
Company s Addres s
Garbage & Trash Half'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:410,-7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 3 - -7
�—1 1
Applicant' s Name: 1—v2 S-{ V [A"— -4-A Telephone No ..)h 23 y 3
Billing Address: +3 3-A-A
Address of Exemption:
Water Works Account No.: �� aZ 9- 507 "5-)
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 Signatu
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 1CAL. j� \ktL-tt31. � S sc k 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
c O+;S4Clmu,rcch u3u12,a11-6,(1c) re , � - . -�-� ►a-3�-�7
CONTRACT PERIOD MUST COVER . 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• 91-4323.
S, - � � v� snip
Date Signature of Aut orized Company Representative
<761 D410_4(3ory\
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: xi 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OFWATERLOO, IOWA �(0/7
Date
Applicant's Name: rias -r urk, ( l Tt '&Sr Telephone No. d5 7Q$r
Billing Address:
Address of Exemption:
Water Works Account No.:
/c)71 5o ',;t2S
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 glify for the exemption.
�t r?21
Applicaxit's Signature
TO BE CC
L•
Oj/PL1oU BY LICENSED GARBAGE AND TRASH HAULER:
/1
(We) Y v vT 1 J '1 4%iltL 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 -Un Contract Contract
i 1{4 t,[.ir-L [k EEO W - f 125 it(7'°20 20
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.
'L- 1
Date
Signature -of Authorized Company Rep sentative
Company's ddress
Garbage & Trash Hauler's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 5D703
City Clerk's Copy - white Customer's Copy - yellow
Exemption year: 2017
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
FIRST WESLEYAN CHURCH Telephone No. 319-232-1272
205 and 211 HAM ND AVE, WATERIOO,IOWA 50702
Address of Exemption: 205 and 211 HAMMOND AVE. WATERLOO,IOWA 50702
Water Works Account No.: 7-20-1190-008568 7-20-1220-008571
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.
Appli , nt' s Sign
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) BLACK HAWK WASTE MANAGEISNT
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
FIRST WESLEYAN CHURCH 205 & 211 HANMNOD AVE.
hereby declare that we are
Iowa, and
that we pick up
Beginning
Date of
Contract
1-1-9017
Ending
Date of
Contract
12-31-17
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 calling 291-4323.
Date
PLEASE RETURN TO:
Signa_ e�`o A�ithor zed Co�npany Representative
811 ISearborn ave. Waterloo,Iowa
Company's Address
Garbage & Traser's Permit License
(issued by Black Hawk County)
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
Applicant's Name:
J
Billing Address: K:� / //, l/
Address of Exemption: 7/ G� e �~
Water Works Account No.:
Telephone No 013Y 3/aj
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.
LD -z,
Z
t--- Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 3\O Y. • Wc.S
Company Name
reby 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
7.0f1 Ty‘..‘ -e
L11 5'11( stw
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
Signature or A thori d C pany Representative
Z\f
-eo
Company's ddress
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