HomeMy WebLinkAboutKExemption year: X11
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
/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.
Signet r
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) FAcka WILL Ac, JQX , 10 (&QI
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:
Customer's Name
Shvc
Yap p Q -
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
32Cre_s#ry
Oc —i— fl r),
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 ca g 291-4323.
Date Signature of ', thorized Company Representative
5 � �
D{c i
Company's Address
Garbage & Trash Ha Ter'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: p' -O t l
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name: Le 1 ( kat os f e Telephone No .3f {-S(oI-%9'%3
Billing Address: )1-46?) ( f JA 5±. 1, J cfe r lo j et __5O 767
Address of Exemption: jbi3b A IA i � ` s"j . IA ) e r /nn_647b7
Water Works Account No.: 10 0 gS8 -3.77 Q 3 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 COMPj,FTED BY,LICENSED GARBAGE AND TRASH HAULER:
(We) ( WIC }iO 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
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 of Authorized Company Representative
S 1 r1cYYn a LtiCJID
Company' d ress
Garbage & Trash au 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
(1.17
Exemption year: 2017
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 11/29/2016
Applicant's Name:
Kimball Ave UMC Telephone No.319-232-4103
Billing Address: 1207 Kimball Ave, Waterloo, IA 50702
Address of Exemption: 1207 Kimball Ave, Waterloo, IA 50702
Water Works Account No.: 8-60-0260-011723
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.
Appl'cant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) awl, S 1
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:
Customer's Name
Wn\\D TN\c,
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
1a1 Uir\AVM %vt V-1-11 12-31-1 i
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 Authorized Company Representative
b-e-af\aNY\
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 4-I'4-17
Applicant's Name:
Billing Address:
Address
of Exemption:
Water Works Account
O\o\c,\ V\uyy Telephone No. S15 -90g- y
\ 3 \ 5 -En eu...x 0 Rue_ t uo *erloo 5
1 5 e LYock) Ue,
No.: kl.--), 5 lace
•706
c�7ol
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 Signattlre
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) ` lod A(. 10q c Ot se- s hereby declare that we are
Company ame
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
Bc*
Beginning Ending
Date of Date of
Contract Contract
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.
-)‘"A--1-7 V3!=ib‘
Date Signature of A horized Company Representative
1)-ea.c\N3ry\ Akre_
Company's Address
Garbage & Tras 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