HomeMy WebLinkAboutLExemption year: ) 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 7',07/ 7
Applicant's Name:
Billing Address:
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Address of Exemption:
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.
Appli
nt's Signatur4
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
Company Name
ereby 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
Address Location of Date of
Customer's Name Garbage/Trash Pick -Up Contract
Iia h Ani �s -70R W . 3 , 1-1-n
Ending
Date of
Contract
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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 calli.. 291-4323.
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Sig orized Company Representative
N11
Company's Address
Garbage & Trash Hauler's Per cense
(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: 2017
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
December 21, 2016
Applicant's Name:
Billing Address:
Pastor JaeHee Lee
Telephone No.
307 West Louise Street, Waterloo, Iowa 50703
(319)883-5773
Address of Exemption: 307 West Louise Street, Waterloo, Iowa 50703
Water Works Account No.: 4-50-0050-056205-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 COMPLETED BY LICENSED GARBAGE. AND TRASH HAULER:
vifXflki
Company 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 Garbage/Trash Pick -Up Contract Contract
a OW''S ( ild irdh 36) W Low -R. fir., v iv -0 Tn
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.
(17_1') C(0
Date
re of Authorized Company Representative
Ocia Mos 51- 1)0'100 ,111- 5-o9o)-
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
Ada) 41