HomeMy WebLinkAboutMExemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
BZW ��Q 107;42/2 Telephone No. (J//C%%2.5 � 7.54/7 (;()j-j2i4Z) 5-6 7C)3
--�
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. 77
Aplican s Sigiiare'
GuP
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 3\GIG ` J Rkre ts9S
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Customer's Name
Address Location of
Garbage/Trash Pick -Up
y declare that we are
Iowa, and that we
CONTRACT P
Beginning
Date of
Contract
pick up
Ending
Date of
Contract
RIOD 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 g 291-4323.
1Date--
Signaure of Authorized Company Representative
61,1
"Q-aPiDli\Or\
Company's Ad ress
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: a017
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date 0/7
Applicant's Name:-�����,GP� 1„P ) Telephone No. o'j- -4,, 73.
Billing Address: /4 g.S" -4 ".i'"4 -6(P wl
Address of Exemption: /6(,5',9,
Water Works Account No. : /150 z; 1 V 6Jd4 3/ lj
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) L>W&X- € wiztstQ 4�J S1��C S`mow
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
\3e, ric\ r - - \ODS, vc e —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 calling 291-4323. ,>
�tea�Jl�
Signre of
l`
ized Company Representative
Company's Address
Garbage & Trash Ha. 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
kM01/21/2017 10:25 FAX
■
411
Exemption year: .(?-(i -7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date i /7' /7
Applicant's Name :Q �' ���J Telephone No 31?-
Billing Address:...( -,16.."-734:7) (. Eo)' r-�-
Address of Exemption: 3 1('fl'- 3?® C
Water Works Account No.;/IL-L:4_0-7 r)-“..1 c.)1j
T request an exemption from Garbage Fees during the current Calendar Year. r
-amp1oy the services of a ,Licensed trash hauler. Only the location where the
trash hauler picks up garbage and trasI, ill y-ualiPy for tha exernntion.
Applicant s Signatur
TO BE COMP ETED BY LICENSED
(We)
AGE AND TRASH HAULER;
�
_Q�hereby declare that we are
"jj''
Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
II001
Beginning Ending
Address Location of Date of Date of
Customer's 1,1Jave Garbage/Trash Pick -UP Contract Contract
016,44 Pte, s ( gL cii f--- I J49(7 42 37)d'7
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 291-433.
-.026/77
Date
ture of Authorized Company Representative
/160 /02tI-RULL
Company's Address
eit1c)L14- SCJ C J d ) y
Garbage & rash Hauler's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE:
715 MULBERRY STREET
wiTERLOO, IOWA 50703
City Clerk's Copy - white Customer's Copy - yellow
-cL-Qa
Exemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date _,.
Applicant's Name: ;7,2c/:)/1/7.4S7 ,_ moVii,/7 Telephone No.
Billing Address: /` d 6/ 8/s-/Gp 4%4,
Address of Exemption: /C20 srj�
Water Works Account No.: )r 10\ N) ( 6) 1 a
41,
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.
App
,!!:‘4°‘—
scants Signature
TO BE COM LETED BY,LICENS,GARAGE AND TRASH HAULER:
(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
CCustomer's Name Garbage/Trash Pick -U, Contract Contract
(fWinWAktkof-- 1;04N-14
1-1-/7 /2-31-J7
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 ear, we hereby agree to notify the Clerk's
Office of this event by calls,.
291-4323.
I-15-I--
iitaitIdT/
Date S'gna ure of Au.!'Orized Company Representative
k
If itlikriou
Coma ' `Address
P
/(
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:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Dated
(I)
vf�
Applicant's Name: b jK/A1S �. . fia e�lephone N /7y7.4a.
Billing Addr ss:
-y
Address of Exemption:
Water Works Account No.:
*,440/7/ 0
f6/n4 X1,2/
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.
p icant's igna ure
TO BE COM
PLETED
BYLIICEN ED GA B1AGExAND T��i•SH HAULER:
(We) V(� If U,
CJ
Company me
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
Address Location of
Customer's Name Garbage/Trash Pick --Up
JF5 Mounf
Beginning Ending
Date of Date of
Contract Contract
J2D e;J s )s -n- 12 -31/7
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 calli.rtg 291-4323.
/2-17 OV1/01 )112A-0Kkle
Date nature of Aut ized Company Representative
?11 -e�a.lbOm M
Company Address
1)
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