HomeMy WebLinkAboutTExemption year: C.0 N I
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
"IA) /
Mit 11 II i7&
AO? HaVnMal
lephone 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.
16111.4e1/42.,
2p licant's Signature
TO BE C PLETED BY LICENSED GARB GE AND TRASH HAULER:
g
(We) CICHOPa' 1� Wil
Company Name
a licensed trash hauler in the City of waterloo,
garbage and refuse at the following location:
hereby declare that we
Address Location of
Customer's Name Garbage/Trash Pick -Up
are
Iowa, and that we pick up
Beginning
Date of
Contract
�.� Tickynas /07 pviiona'Safri±
Ending
Date of
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.
Inthe event that the above
during the current calendar
Office of this event by calli
Da--169
av(,/'
person discontinues service with said company
y ar, we hereby agree to notify the Clerk's
291-4323.
natiJr-of Auth. ze. Company Representative
�6]
Compan 's ddres
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: .Zdl
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date
AS'Sh 3!g
Applicant's Name: 1 r e ti Y 1 1 (ry r AO Y. -a. Telephone No. 2 3 c- 67 5 -
Billing Address: 3B'=1 y L. ,,, IA/ 4-1 Uc, , , 5717 0 1
5e33� 3 Tr -35;3 - 3sr v9 , 3�SS 3 - - T r
Address of Exemption: 3�G 3, 35 -Gs , 3p xL 3g Yqr 3£r 3G� ' 3Sr3�i 7 v
a•-• 2.73- 1 frv3cl iz22.7S-- 6-6Y5 7.0
Water Works Account No.: 11 7- 2 Z T - 4-1 s- c 3e t t A 2-) 9 - .5-/1/* 0 30
to zz-t(e- 4'tSrd3c, t«.7-7`1— 6--(0/.."t7
1S7/'I4-1-6 I — 5-1 5 030
L.
vat LL.,
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.
KOW/, V cti➢ v vim ✓-
Applicar�jt's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 5 j- rAckwoojE 14,L e t- , - j A) hereby declare that we are
Company Name D
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 N,Ine Garbage/Trash. Pick -Up Contract .Contract
% r•- )i- 11 Co �do�
2155;' T f io'" — L 1-'1,016r7
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.
Date Signature of Authoizd Company Representative
• -44
Company's Address
04,
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