HomeMy WebLinkAboutU-VExemption year :
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date /)
317
Applicant's Name: Zi7157-/- Telephone No .23'2 - //' �p
Billing Address: 4A JO S2r�>-�7� fp_ 44)a.yi-r. -o , ,,a)a �o�o
Address of Exemption: /9/ -/g;1 Th
Water Works Account No.: // f 527L/ -- 4e)//
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)'1act \i.\V JQ..siR, ScYsiSildhereby 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:
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
-��� %Z , 1 SA-. 1 -1 -fl I2 --3I---1%
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 1-4323.
is -a-1 ID
Sign
rized Company Representative
Garbage h 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: �i®/ %
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date /2-/ -
Applicant's Name:
Billing Address:
Address
S // ///75/ r
-2 /D
of Exemption: a fo 45- -,1-tGj�
Water Works Account No.:
Telephone
cO-1r, f c' d'/D-o
3,9
No . ?3,2 -iy_5-2)
..6.54: % P7
.Z -C -Lc) 7 c
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) Blo,c \-\-ap3LWeLq-e rxWe)50,1
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Address Location of
Customer's Name Garbage/Trash Pick -Up
hereby declare that we are
Iowa, and that we pick up
Beginning Ending
Date of Date of
Contract Contract
a IV10 Srri �r- 1D1 --3I--1-7
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.
4,-e a-- \U
Signature ohorize Company Representative
(Z\ N:) P\ -\PQ -
Company's Address
Garbage & Trasher'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 �} ) ,, )l
Date o
Applicant's Name:Tele hone No. -S/' -'72K
Billing Address: S l y(/ � %�'Zer vizi
Address of Exemption:���% �(j�0�
Water Works Account No.: %,C) 7 Sc3' ^__S7/3 3 3 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 qualif for the exemption.
Applicant's S'gnature
TO BE COMPLETED BY LICENSED GARBAGE
(AANDD TRASH HAULER:
C
(We) ,Vx_c lu 3.v So
mpan Name
Q
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
Azano.w.L1 \10, ay t. S. coot lrvt. ►-1-17 1Z--3 H -2
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.
ate
—17
44�`� tfUD
Sign u e df Aut oriz Company Representative
Company's AddYess
t.�
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:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 4R— g"" L 7
Applicant's Name:
Billing Address:
Address of Exempti
I/lfl/G f k‘1r Telephone No.,3 051
on:
No.: ./4f)�, —.?7 o/
Z/
Water Works Account
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) 'B‘ Q,C. `L wuksv.Vtucto,MSV
Company Name 1
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
Customer's Name Garbage/Trash Pick -Up
Beginning Ending
Date of Date of
Contract Contract
9)
7.227/
\jay.d.er5e4? lbsc.rr?.10. S13b Svsee4-vo,a0Y' 1-1-41 17-31-1l
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 calf g 291-4323.
,r\ 9/J
Date Signature of Aut{ rize 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
Exemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date �'� SC./7
Applicant's Name::u..14 /
Billing Address:
Address of Exemption: S�3r3
l4.6 -7 -
Telephone No. 3/9-'/_cs
moi' Ze
�7Z-2/4
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.
Applicant's Signatua/711,/‘Se
re
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) `]1,E.1.1.AkeiLia_SV__(j ' ySl v� 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:
Beginning
Address Location of Date of
Customer's Name Garbage/Trash Pick -Up Contract
i tr c rSeia - Sa33 StikettUabrGC.
Ending
Date of
Contract
1--i-11 )L-3)-)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.
)\`G\ -n
Date
Si atu e of Aut ized^e4m
gn pang Representative
\ DJ2‘144)()ON ,4Company's Addss
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: 2 X17
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
31)-1 117
Applicant's Name: I1ZL iN i, 1NC,
Billing Address:
Telephone No.�i� z3s� f
214, k.). ! ft" 5-u7 0 i
Address of Exemption: PAO COMM CtNLS y V.)0 -7i5.,/1/44 5-01V7c 'Z
Water Works Account No.: A140r,'-'D 1 ` 2. i
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) gt jib LJiitS' 19(s10 . 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
Address Location of
Garbage/Trash Pick -Up
'I rl Ct,c-f, , rrc. 2l4 - tk-
Beginning
Date of
Contract
Ending
Date of
Contract
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 291-4323.
Date
_ \L_
Sign lure of u horized Company Representative
R\A oaaaoyy\
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
0
Exemption year: Z01
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA ii
Date .> (r/ 1
Applicant's Name: C,LEAK, Telephone No. -2'3-3'7f
Billing Address: 2\Ip tiJ. 4' t S-01 C y
Address of Exemption:
i2� 0 171€250l4S t _ lAlmE3m40 IN
`.707(0-1.-
Water
.707r0i
Water Works Account No.: l ( Moo -9'001
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.
CApplicant ^ s i ure
Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) W,+P +401V- WWIks OiAsk, 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:
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up ContractlContracti
iL4
j 4 G JEi� , ►NL, Zi, W. 1 t+'t ST, his -1 teo I IN 5070- 10)-1 1)-1 7 2-l` 11-7
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 calling291-4323.
Date Signature of Au
z Company Representative
oiPCLJ
�d ress r
u
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: 20).")
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name: V 7f Ctp 3 Telephone No . 3j=i- Z '3 3 1,
Billing Address: Zd 1,1)�� S� - r� %� f 1`- 4-07 ?-
Address of Exemption:
Water Works Account No.: 1‘5
p ink ,�'� S i � � i t Y� S ®'70
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.
44.
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) '..1,-Gt #46otiNi'1- ws-m- Dispost,k,
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Address Location of
Customer's Name Garbage/Trash Pick -Up
hereby declare that we are
Iowa, and that we pick up
Beginning Ending
Date of Date of
Contract Contract
- p c e e , r (\1C, Zi Co G,i• 07 1wti4 Wo 1 S%Vri
CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR
1.11.: l r7
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
during
Office
event that the above person discontinues service with said company
the current calendar year, we hereby agree to notify the Clerk's
of this event by calling 291-4323.
l
Si a ture of A„th rizCompany Representative
c
2) -0 -()L -07Q)(311)(\\
Company's Address
Garbage & Trash Hauler'sermit 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
V\
Exemption year: Zan
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 3127%17
Applicant's Name: IP&$i 1 qatAa-5 /tc-. Telephone No.
Billing Address:
Zig W • Vd �i . dpi-pc-i-cJ J & X702
Address of Exemption:
-21,3 '� ' C'±K E 1 . NvP � V ® 7A Z
Water Works Account No.: a574.;-2 6-tg U l
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) Uai-G 'tib (A*;:rE i)(4'.4001.164.,
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
J wy9 \ P&ass; /Pict 21p03- Il"ST. ii,k, 0, 1P 5 02- it 4, 1z14,
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.
3- H1
tQ
Date S
ized Company Representative
i atu e of
S i k Ocet e.61 -PAP& &15 - oo its- 5o7O Z
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