HomeMy WebLinkAboutGExemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /;2.-/9-;01 b
Applicant's Name: /ez---:r.,3/c.✓ . 60e/':;r ry-_ 3 Telephone Nc 3/ 9Y1 ?.3 2Z -N
Billing Address: z.`i ' a LI 4U L.. OA -Le -too rA 50 4
Address of Exemption:
Water Works Account No.: 6 1 3 -Z i ^ 5 ) ' 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.
• Alicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
Company Nam
osa-k 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
1-c-YaMe r GoxC1,C\ 1 ads Qtioer Pt -v -e- 1-1- } -1 i -31-1 R
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 of Authorized Company Representative
Company's Address
Garbage & "— 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
V
Exemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date P /l
/ `7
Applicant's Name: )<o % 6/1/M2fov Telephone No.2 /"4(26?
Billing Address: -72, 7 ,SOO7w sr
Address of Exemption: raj 5o 677/ 57-
Water
7
Water Works Account No.:
/2.212 Oy'),c9
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.
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
'Aj )vr ontli4 - hereby declare that we are
Company Nam
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
5z'iri xxn ") (Sa h lu 4CO HU 0 ki
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.
;)d -CS' n
Date Signature of Authorized Company Representative
a ; laces a, /V Ico) GA W%
Company's Address
a c\e_ (a hW. f Pal�h' )91,
G bage & ras 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:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
Address
YURT gibrelsevy
of Exemption:
72r) .SouT/f 5r
Water Works Account No.:
Telephone
No.a?7 b/GoY2
5/7 we -s7 iii' 57
O[ sp, 0/7a
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.
0J117.1aery /
Applicant's Signature
TO BE CODHL
(We) r6l
TED BY LICENSED GARBAGE AND TRASH HAULER:
f v►rcfl 1)1,1, ]-z.
Company Name
a licensed trash hauler in the City of Waterloo, Iowa,
garbage and refuse at the following location:
hereby declare that we are
and that we pick up
Beginning
Address Location of Date of
Customer's Name Garbage/Trash Pick -Up Contract
$J(o & &) wiz Oh
CONTRACT PERIOD MUST COVER AT LEAST CURRENT
Ending
Date of
Contract
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.
� 3 -
Date Signature of Authorized Company Representative
aSc�
ompany's Address
co 7:1514 S2U)-
x 20)-An0,71254 Hey* 1��149LGarbage & Trash Hauler's Permit Li ense
(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: aDt 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
1-17-Qcr7
6lI
Applicant's Name: NWid Gl Cae.5 Telephone No. 430 -%( 3 .,
Billing Address: .3L5 fGC tho Sf (,,c'ca-c-f- [
Address of Exemption: .SeLVIN
Water Works Account No.:
0-- Q (0 7 O G' .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.
pplicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) TA)6(....‘\1101LUI WC1S44a_
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
aav . Gomes 2„.? 15 00,6 Si-- IL- 30 -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.
-a9-17
Date
G 4.1_PWW
ignature of Authorized Comp ny Representative
U6( 4,2e ,r,‘7-/7
Company s Address
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
Exemption year:
.wri 0
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
G mac- Fi/ows ,p Ckoec/
l 760 Cel/ &shin ak.E
Telephone
No. 3/''235 95'6
Address of Exemption: SA-dhE
Water Works Account No.: r 2-5 (76,‘--5-0 l 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.
Applicant s S gnature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 11A+UL lL 01.!j
-company Name
a licensed trash hauler in the City of Waterloo, Iowa,
garbage and refuse at the following location:
hereby
Customer's Name
declare that we are
and that we pick up
Beginning
Address Location of Date of
Garbage/Trash Pick -Up Contract
I -?6b lsk Sivn
1-H
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 29]4323.
n
Date
SignatuAuth2iridCany Representative
Company's ddr ss
Wakefk,
c(I)
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: A0//1
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA �p
Date hj ,�,k�,P7/� �,ANt '
Applicant's Name:
Billing Address:
t fl/J 1JJ4'bf,Pb ILl Telephone No.3/1, 35,a0c
OM- L ter 6 iaitrA L4JQhr/UU 14 Z7
Address of Exemption: Sa1ALI
Water Works Account No .: l tY/%J%fp-,R ,�r,/(4 L DIV` 39'
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.
!It
�rr/Y� ��
plicant s Signatu
CG Max( a %
4
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 310 . ReUkL Wm.St wbsa-Q)
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
Li-ki lf\.Q.am C,IAura\ lo2� t-1 U� . $�"`-'' S 4- 1, -k --11 \D. -F.)1
—�
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 call! ._ 291-4323.
\D-7—H-1.uo
Date
Si•'!'ature ohorized Company Representative
(T I . 0-QOAraNYN NQ
Company's Address
Garbage & ash 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
w
Exemption year:
o2a/7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /1-i -24"
Applicant's Name: ditzer +2t"erm au" -e-4 Telephone No.3l133 y1
Billing Address: ,j 1D/ykxl2ed St utile/— v .so7O/
Address of Exemption: t%?DAltynv/it r ima544 id -.ie Wrl 5)
Water Works Account No.: //-VP'0W0- WrC/_,j 7 JD_6t--c-1g5 - niC
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.
App6`GiG
licant's ':igature
TO BE COMPLETED BY htcany LICENNSED GARBAGE AND t'RASH HAULER:
444
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 Ending
Address Location of Date of Date of
Customer's Name GarbaaelTrash Pick -Up Contract Contract
(Ya,—.It- e414 rfi5•2a OA/ag+il
i-1-17 /o2-3/17
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 291y4323.
Date Signature of Authorized Company Representative
7� � 4/
C mpany's Address
„'f
Garbage & Trash Hauler's Pe at 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
15 LL9 -.°)b5 r
Exemption year: j 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
r;
Applicant's Name: ' O)�rnjelephone No.
Billing Address: \..13//7-2:27/...di ` 1
Address of Exemption: 2/// 7<t
Water Works Account No.: IC ) ; F,4" S )
0
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 GARBA _ AND TRASH HAULER:
(We)
ompany ame
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
hereby declare that we are
Iowa,
and that we pick up
Beginning
Address Location of Date of
Customer's Name Garbage/Trash �P�ick-Up Contract
limp.C- li&aki�1 37/7 7..F /✓
CONTRACT PERIOD MUST COVER AT LEAS
Ending
Date of
Contract
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 •_reby agree to notify the Clerk's
Office of this event by calling 291-4
of Aut-o 'zed Company Representative
°51 C
Comp ny'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 50703
City Clerk's Copy - white Customer's Copy - yellow