HomeMy WebLinkAboutHExemption year: t2)/7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date D -r"
Applicant's Name:
Billing Address:
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Address of Exemption: e31=1 01
Water Works Account No.: it 97t!l- 6.D.g"i 7 //74'5' 50 g'i677
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.
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Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) Nac1L \A.Lw L UJaSt7t r)( SIASALereby 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
�ptw.v,r.c \ 1�ve Br'2't'1�.rer Clnkrrch j��i 1-lh�nnn+wnC� e 1-1-17 I2 -31-Y7
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CONTRACT PERIOD MUS O R 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.-aA--1`0
Sign of Auth.red Co ny Representative
Company's
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: a t:9/7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date //
Applicant's Name:
Billing Address:
Address of Exemption:
Are: /1( Telephone No"z 7-4%
Water Works Account No.: � &94 --- -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 Signature
TO BE COMPLETED BY LICENSED GA AGE AND TRASH HAULER:
(We) LUQ* 0a00)0(15Ale t 0saL
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
le,6c_cck k `42 6c/0(v-cis 3-L 1-1- I 12^3 HT
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.
1111A��
ure of A
Da le V //-) 1p
_ //%/I
f Orized Com any Representative
GI AG, ✓it. JOY -
Company
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:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date `-4,31• I
Applicant's Name:
Billing Address:
nPannprTh i -n Telephone No -31°1-9621-01k
ISa
Address of Exemption:
Ill o W kr \JG eAuo
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.
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) '.Lo EASal Lcvati 1Q -t ---AC. wri 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:
Address Location of
Customer's Name Garbage/Trash Pick -Up
O p t- i -c c 3 15a, 5 -z -
CONTRACT PERIOD MUST COVER AT LEAST CURRENT
Beginning
Date of
Contract
1 C_L_I lZ
CALENDAR
Ending
Date of
Contract
YEAR
c -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.
( '-ti 17
Date
PLEASE RETURN TO:
Signature of Authorized Company Representative
Company's Address
r6.0 ri eF P 1-13 131 c1 L Ha rifle, 070,11j
Garbage & Trash Hauler'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: ,20/17
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 5 -/_7-
Applicant's Name: �. Telephone No.
� 1
Billing Address: )) °c_C )
Address of Exemption: 1205 6 64.jjE_
Water Works Account No.: 1 o / -' 2G t% g/
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 wi • a iffor the exemption.
A 1icant's Si. atur e
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 1,3a nQ 1('r.3 hereby declare that we are
ompany Name
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
h)o
• Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
/0`1OS Qi'S4e//3t4Pr49 /" I,/ /a -.3A
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 calling 291-4323.
Date Signature
•
iv< R
Authorized Company Representative
35-Y .4g
Company's Addr
Garbage & rash 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:
ae72
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA 7
Date 9- - /✓
Applicant's Name:
li k //', 7-4o
Telephone No. 23)- )- 79 7
Billing Address: /pg.' 3teff 4 7- B
p /7,91 IllIn �,u� ! � o 3 I./} �
Address of Exemption:
Water Works Account No.:
a..q of r-° s-
I request an exemption from Garbage Fees during the current Calendar Year.
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.
7261/./e4Applicant' ss Signature
TO BE COMP TED BY LICENSED GARBAGE AND TRASH HAULER:
(We) f;,t && (%!I'"= f%t/gito
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
/- /- / `7 /3 7/ /,7
CONTRACT PERIOD MUST COVER RI 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
Sirs-ture of Authorized Company Representative
A, e
Company's Addres
Garbage & Trask4 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: '/2
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date - 7
Applicant's Name:
Billing Address:
G it /V r A 0
cf 7c " ifir
Telephone No. ,12. 3,) i'
Address of Exemption: /79$7 0/ 1r// S( (4
Water Works Account
No.:
3,6i
/ / a 9 KC: 5-d 3 r,
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 COMPIjTED BY LICENSED GARBAGE AND TRASH HAULER:
(We) if((.e€j�ieCtr 1/vc((rrncy r
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
hereby declare that
Iowa, and that we
Beginning
Address Location of Date of
Customer's NamP Garbage/Trash"Pick-Up' Contract
/ /7 /
we are
pick up
Ending
Date of
Contract
/r2 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, Citi -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.
7
Date S.,gn€ture.of Authorized Company Representative
�( �(:(/
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