HomeMy WebLinkAboutSExemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Applicant's Name:
Billing Address:
Address of Exemption:
Water Works Account No.:
Date
�;r .l,e(5iN
ict
0
Telephone No.3[ 9 d30 3z
/00S / — SOo 3e .
I request an exemption from Garbage Fees during the current Calendar Year. I
employ the services of a licensed trash ha ler. Only the location where the
trash hauler picks up garbage and tras ill qualify fohe exemption.
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) AC.24.1jr ("10L
Company Name
a licensed trash hauler in the City of Waterloo, Iowa,
garbage and refuse at the following location:
hereby declare that
Address Location of
Customer's Name Garbage/Trash Pick -Up
9-74.A.utc 5A-.1 szt-so c r 32.4 6C-6- Q.4-ecc. 5 -
and that we
Beginning
Date of
Contract
[`Z
we are
pick up
Ending
Date of
Contract
--c
CONTRACT PERIOD MUST COVER I 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.
OjDate ( ( — �—
Signature of Authorized Company Representative
PLEASE RETURN TO:
Z(a(z-. `C 4'z
Company's Address
oA-) t=kcja a €LC t w e Q0°2=
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: v43V-7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 1 cn
1�
Applicant's Name: Il b(\t'&t Telephone NoN47-1e0i
Billing Address: �' �, ' iT
Address of Exemption: �• �` Q ct—q 0\, p —1. 501(Z
Water Works Account No.:
iso l sood 8�
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.
Applican$'s Signature
TO BE COMPLETED BY
Y LICENNSED GARBAGE AND TRASH ER:
(We) BIOICid+et.liX WQ, DiSp^
ereby 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:
Address Location of
Customer's Name Garbage/Trash Pick --Up
Beginning Ending
Date of Date of
Contract Contract
C,`'lVY) id 3Q L trig - I- -17 t-31-1%
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 cal 291-4323.
-1--4l-1]
Date
Sig ?fature of th orize(r.
Company Representative
PWQ-
Company's Addres
Garbage & Trash =auler'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:
C l,_.` t f
PRIVATE HAULER GARBAGE EXEMPTION APPL
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Ir.
CATION
Applicant's Name:
Billing Address:
-C ?) K-6\ ( - ter c
Telephone No.` FJ1
n ij;
Address of Exemption:
Water Works Account No.:
G3 \i`- \,\2
C, V
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.
Applican''s Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HA.U, ER:
(We) iI�,�l�l!c��6L ! r--
�� ;
.5 � C� 1 12 ereby declare that we are
Company Name
a licensed trash hauler in the City of Waterloo, Iowa,
garbage and refuse at the following location:
Customer's Name
V�CY 1.1 hni) t0 -1 -
and that we pick up
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
f.
7' 1 l
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. 1, 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 call,i-cg 291-4323.
Date Signature` -Of AEuth'oriaefttompany Representative
1-4i-171
PLEASE RETURN TO:
t
Company's Addres,sm
j
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
r
Exemption year:(4)/Z
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Applicant's Name:
Billing Address:
Date
//q//7
Telephone No -/9.---y31/./2.5-1 -4*
Address of Exemption:
Water Works Account No
6-/ J Pd- 1.11/DO )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 ify for the exemption.
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) a.c,\L \L VJC Ls\ --e Ds
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
t� av ►'c\S r\ -f \ \ c3\ Nact t 201 -�� —t � � a-3 ►-���]
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
we)�Bo.es
Signature of thorized Company Representative
Y\ teoJbxim Acvc
Company's Address
Garbage & Trash Haui'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
Applicant's Name: &G -c;
Billing Address: �v2
Address of Exemption:
Telephone Ne el9 5(
a er Works Accou Nb�: 1® C9
.4)W
.5'a2 3
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 Signat
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 1GL,YL, VoJac, w P, 0QApus%�-C�
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
Address Location of
Garbage/Trash Pick -Up
Sa. Lam, eke.,
Beginning Ending
Date of Date of
Contract Contract
Va:---3\-17
CONTRACT PERIOD MUST COVER _Aa 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 call' = 291-4323.
\-3D—fl
Date
Sig ature410
of
horized Company Representative
l 1
Dea
Company's Addres
OCAlY1
Garbage & Trash 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
Exemption year: apl-]
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date /— )C—C7
Applicant's Name:
Billing Address:
•
Telephone No.f,-kr--rc7Yle
Address of Exemption:
Water Works Account No.: 2.;;w c2 - .5 Q9e' /V16
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 Signat
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) S?blafl \-\) U. WaS
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
ereby declare that we are
Customer's Name
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
at el Large
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 callin 291-4323.
Date
Signature of A
orized company Representative
IkaAr-
Company' s_ Address
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: Q /7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /- 3 f /7
Applicant's Name:
Billing Address:
Address of Exemption:
Water Works Account No.:
Telephone No. (9 -Q// 7
8(9 Lo ye?
/03/94/ -
v (Oa -1-e rlc>zs
S CH H7
SO70 3
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.
tP.
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) i 11LCX 6"lTjt V�J0-u VL, spCRIA
Company Name
hereby declare that we are
a licensed trash hauler in the City of Waterloo, Iowa,
garbage and refuse at the following location:
Customer's Name
S1Leve. Sc-lo+iw in
Address Location of
Garbage/Trash Pick -Up
4/cO7 CAJI� Vercett j 1�v�
and that we pick up
Beginning
Date of
Contract
Ending
Date of
Contract
/ 7
CONTRACT PERIOD MUST COVER A�,_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 A ihorized Company Representative
��l Denfl�urv�A�re
Company's Address
Garbage & Trash Hai f'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: a, ()1-1
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 1-11-1-1
Applicant's Name:
St. Ansgar Lutheran Church Telephone No.232-2733
Billing Address: 1122 West 11th Street Waterloo, IA X.RXRX 50702
Address of Ememption:1122 West llth St.
TV 11
Water Works Account No.:
125763-508189
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
Betty L. Spence, Treasurer
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) Bate.. 4 CLUJ V Waste Dc sow 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:
Customer's Name
Beginning Ending
—Address -Location of - - -Date-of - Date of
Garbage/Trash Pick -Up Contract Contract
s -t . A r ssar LuAhe. an i 1 as w ► i �� S, - -I - "1 1 a -�
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.
v-\1-11 3os
Date Signature of uthorized Company Representative
`e;1,\, 1) -ear 66M /v
Y
Compan sAddress
Garbage & 'brash 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:
2017
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
December 21, 2016
Applicant's Name: St. Paul's United Methodist Church Telephone No. (319)232-4790
Billing Address : 207 West Louise Street, Waterloo, Iowa 50703
Address of Exemption: 207 West Louise Street, Waterloo, Iowa 50703
Water Works Account No .: 4-50-0035-004803-0 ; 4-50-0036-037626K
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 'sjjignature
TO BE COMPLE ED BY LICENSED GARBAGE
(We)
1
TRASH HAULER:
Company ame
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:
Address Location of
Beginning Ending
Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
50W1 Urns fin• W Lc .0 t & l?t /4)1- r9
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 291-432
lam. I .3 (RP
Date SignatureAuthorized Cbmpany Representative
p(01 S.) 1)3k)O) l
Co any's A dress
Garbage & Trash auler'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: c 2t'i7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
c7ei
Applicant's Name:
Billing Address:
kin
s— rye...JR
/ UO
y
Telephone No.3ict-trO"?72v
Address of Exemption: %(o(
Water Works Account No.:
I(rr(ap -3iia3
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.
7IppTIcant Signatur
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
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
VOnr crate al7(c/ �ssr� /-/-/7 /2-3/- /7
kONTRACT PERIOD MUST COVER AT ':EAST 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
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