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HomeMy WebLinkAboutNExemption year: PRIVATE HAULER GARBAGE EXEMPTION APPLICATION RESIDENTIAL CUSTOMERS ONLY CITY OF WATERLOO, IOWA Date Applicant's Name: A?<1,-M4PVpp Billing Address: L©7r,J tA Q J& v& Telephone No,,,�l ' ,..qg Address of Exemption: Water Works Account No.: .34 2J907/ 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 140 s Signature' TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER: (We) ? O t 1'1-zot,\Q,. , Sposca_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: Beginning Ending Address Location of Date of Date of Customer's Name Garbage/Trash Pick -Up Contract Contract Nrar�,�� SS Lc —I —11 1a-31---1, CONTRACT PERIOD MUST COVER AM ,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 horize• Company Representative �6 \ I U -e curloon(\ Company's Address kue Garbage & Trasuler'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 a._-2 );L I� Applicant's Name: CW/B1440/40.2-;-W- si l14 40/40._ -;-W- Telephone No-3)WW8119 Billing Address: 2(%73Lep/t/ i4y C J Address of Exemption: Water Works Account No.: 346e21er1 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. Applic is Signatur TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER: (We) W-01 kUaj t j0 SO SG l 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 NO,teN`S Vc1, \b 2-0TS L c ,k A re� 11 VD --31-1-1 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 Auuhorized Company Representative g1,1 /rie Company's Address Garbage & Trash Haulers 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: C;0/7 PRIVATE HAULER GARBAGE EXEMPTION APPLICATION RESIDENTIAL CUSTOMERS ONLY CITY OF WATERLOO, IOWA Date / -aQ -/'� Applicant's Name: Billing Address: Address of Exemption: ,1 n �,Ut1419P 4,419/- Telephone 7/L> 7/ n Blr d iLiT `6, fit= Water Works Account No.: /6.?%Q33--3"00/a3/ No-a33s71o�,5! 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. pplicant's ignat re TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER: (We) nt T- tYlV Ir C7 rY) tflfci j _ 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 J ew 4-1. a M1s3ionar'1 OrivrCIN Address Location of Garbage/Trash Pick -Up Ito BratuctrActS sr CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR Beginning Ending Date of Date of Contract Contract t11117 cvrrt 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. LJ • Signature of Author' ed Company Representative ZirzT ST - LAVA 7-,L.1010 T-L VATQLD , j Sctswr Company's Address jU G - IZq 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