HomeMy WebLinkAboutI-JExemption year: .7.12 17
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date D-ee_. ,a4•7/ (2.0)0
Applicant's Name: p vl5 f y1 Telephone No.,,0,- �f
Billing Address: (a01 ' 4 m m t G74 - v
Address of Exemption: .3",07 l -a t )1t -lx ST --
Water Works Account No.: /- ,5 7 -/-71‘,0- t;, oy) L a4. (<.
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'
nature
TO BE CO PLETED BY` LICENSED GARBAGE AND TRASH HAULER:
V
(We)
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
1 o r,A. YeASavt ,9.o7 e_a.s7- w"` 5t 17`1 7 12 31 /
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 calling 291-4323.
Signature of Authorized Company Representative
ik4 4c//1 --///;p 6/6
Company' 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
0
Q
Exemption year: a O 1 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date ..).41, c 2h r ,).D 1
Applicant's Name:
Billing Address:
Address
j 1-, irn , j v\,j t'/1 Telephone No .2
GO V h14,n m avid »fie
of Exemption: al -7 F_ASt- 10-1N Sf
Water Works Account No.:
170577
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.
Ism
Applicant'
TO BE C LETED BY LI E GE AND TRASH HAULER:
(We) 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:
Customer's Name
Beginning
Address Location of Date of
Garbage/Trash Pick -Up Contract
0.17 F14. i- [1:4-k 51. 1 7
Ending
Date of
Contract
1241/17
CONT=RACT 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 here• agree to notify the Clerk's
Office of this event by callin
Dl?-a9� r
Signature of Authorized Company Representative
cre,"2-4
Company's Address
7
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: 010/7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date 'Pee , 90/4,
Applicant's Name:
Billing Address:
Address of Exemption:
Telephone No.,., 3' -4'29
LC 4 f;Gl S A-v�
G� l St -
ami
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 Signature
TO BE CO i ETED 4BY'LIC SED GArgA
(We)
E AND TRASH HAULER:
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Customer's Name
hereby declare that we are
Iowa, and that
Beginning
Address Location of Date of
Garbage/Trash Pick -Up Contract
?-. 1 asst St 1 1 t 7
CONTRACT PERIOD MUST COVER Al LEAST CURRENT
we pick up
Ending
Date of
Contract
/2.130,7
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 291-43
D to
atur
Authorized Company Representative
061 LOyt1
Company's Address
q 7
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: 11) ! 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
DateJ7 _ 26.
Applicant's Name:
Billing Address:
Address of Exemption:
J erScr\ Telephone No.;23/7;29/
(t 71/4 C/ A Ye_
ah d !-} ye
Water Works Account No.:
/G' 0:2100 -UCO _ 22/ -0
1 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
ature
TO BE C PLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) ✓
0C-.4>
Col«p ny Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Customer's Name
o
hereby declare that we are
Iowa, and that
Beginning
Address Location of Date of
Garbage/Trash Pick -Up Contract
lov V ,yamlel mond /lie /i // 7
we pick up
Ending
Date of
Contract
•
/ 21y//l7
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 /2-2_9- / ‘ .s •�%
PLEASE RETURN TO:
gnature of Au orized Company Representative
ev/I-Xo /
Company's Address
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: 7-6
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /-- ^ 2417
Applicant's Name:9 ‘ Lt \ V & (5-41-4)Telephone No .L9 -234-53e`--
Billing Address: 1 Al 'U nth Sir `, WATefLtzeitchnik 5C c3
Address of Exemption: ( `<-✓ Lilt) ST i,to 1567°3
Water Works Account No.:
'.ac23%3
I request an exemption from Garbage Fees during the current Calendar Year. I
employ the services of a licensed trash .ul- Only the location where the:
trash hauler picks up garbage and trash ivalify f ` the exe'ption.
icant's Signat-re
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) IES\QC.``
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
ANs
eclare that we are
Address Location of
Customer's Name Garbage/Trash Pick -Up
1-e. e UMC, 1 toaS E Lith al-
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 cal 291-4323.
Dat e
Sign ure of Autri ed Company Representative
Company's Address
urn
Garbage & Trash Hauler's\P\ermit 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: i-Oi
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:1/421
Address of Exemption:
Water Works Account No.:
Telephone No.319-2
voATE zt-o0 , te\iNiA 507x3
567c3
.. EAS i t1t5
5 36 -- 9•x2373
I request an exemption from Garbage Fees during the current Calendar Year. I
employ the services of a licensed trash l�-ule.f: Only the location where the.
trash hauler picks up garbage and trash7alilye/qualify fyr the exemption.
fj
/,/
P p,licant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) L\C\C Ci u� �, � 1
1Siefeeclare 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
E L S b
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 cal]Jng 291-4323.
Date
v
y P,
(
Signature of Auth rized Company Representative
c \ r) -Q
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