HomeMy WebLinkAboutW-ZExemption year: c2 a/ /
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /-/S---/-2
Applicant's Name:
Billing Address:
Telephone No.3/9„?39-7'//d
Address of Exemption: / �' roF
Water Works Account No.: /? 7/.54- S/O%27 5/q - S-70 g".0
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 Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)aCI-\\ -m N i.J1 SpO I
p y 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:
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
(304,nW0,14cor5
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 k Signa urf Au orize Company Representative
0Jacuiloonie.
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: a o / 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date f-/37-7
Applicant's Name:
Billing Address: S yo V /Cvrrr�,E', cvX
Address of Exemption:
Telephone No.
s e(o y et, .J,C -
Water Works Account No.: /277/5-/-
I
.7%/s/-
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.
. .x-o'u F- GJ a 4 -
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) B\Qc1L 4ietDk1 j D , OiS
o_ any 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
mixA 1/-f(. 1----n
CONTRACT PERIOD MUST COVER Af 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
Sig 'attire o hori
i
I'M Company -epresentative
eakrIroni\
Company's Address
OS)'
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 )7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA'
Date /2r C30a Q �
Applicant's Name:
Billing Address: /� (2,64), -Pe j, Sz,s70/
Address of Exemption: 7/2K ,er4rila,?a 4,
Water Works Account No.: 196 - 60 - 3927)
-Tp €.-(2. (Oard Telephone No,jj'._ 2 /5-2/4
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.
e)d
Applicant's Signatu e
/72
0
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
3/Eck 6“.A.) j was-} * 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
sncg isrdE0
Beginning Ending
Address Location of Date of Date of
Garbage/Trash ' Pick-jjUp ,, // Contract Contract
7/772 &i ,-, �/,g /-i"- //7 ja-3/-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. 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
Exemption year:
aaf7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA / 1
Applicant's Name QU
Billing Address:
irntAsiN
/0C/
Address of Exemption:
Water Works Account No.:
Date
..4sa n4.e.
elephone No
s- (p.- 7 7O -otf 7a5--0
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/�B , FICENSE GARBAGE TRASH HAULER:
(We) BICLCt ! `'�`�`�`�--��s� hereby declare that we are
Company Name
a licensed trash hauler in the City of Waterloo, Iowa,
garbage and refuse at the following location:
Address Location of
Customer's Name Garbage/Trash Pick -Up
LL.)es\-rhk rS r Pres uk,r y3 \ Ave -
and that we pick up
Beginning Ending
Date of Date of
Contract 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.
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.
1 4�
Date
5ignC�tus.@ `S ��s iOri�e Company Representative
‘Dorn Nye --
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:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date
Applicant's Name:
o Lat9oci
Telephone No g1g i/d -9S'52
Billing Address: n%aq Cia,(1 rea2-1—
Address of Exemption: 02;411 41kj ; 1 i -
Water Works Account No.: / 6 5 g 17 -- f ,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 w .ualify for the exemption.
ant's4-44
Signature
TO BE, COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 1c� L 3t W«. 4(11 D\Scpbby 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
P•O\CN \.)30
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
aaq Clams S+.
1-1'1 1� 31 17
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.
Date Signure o Authrized Company Representative
\ De(' VIr(,rn
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: 4c/7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date Poi/e/4, i? v20/‘
Applicant's Name ami Elai kt f/L aeil h jay Telephone No3/.%40— 1 5
VO g 'm ba 11 14v e4 4 a W aierloal 111 _07.47 ---?e9/-5
._ gip k;m hdlifaew
Billing Address:
Address of Exemption:
Water Works Account No.: %//25j5 dBrf�'
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.
/a/t; Y ,�
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AN TRASH HAULER:
(We)
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
✓4�
/41_4/7
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.
Date
Signature of Authorized Company Representative
ilo
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
v\
V\
Exemption year: 26/ 7
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
. CITY OF WATERLOO, IOWA
Date /V de/pAok- / v206
Applicant's Name: Zinn Ej/r lfe l:Ca / s,,i//�� ✓cio Ckfr-c. Telephone No .,3/7 7 j 7FXf..S
Billing Address: g`/o „, iar/ f�uea,tie. Writer/05 5070,7 -?t /✓
/ 1tst 4/'* $ ee`-
Address of Exemption:
Water Works Account No. : /2 1e-c1J
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
��Cc`�SU Gi`Gy�
TO BE COMPLE ED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
I ealc
ompany 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
Customer's Name
?4"A'
`t..iAl v v
Address Location of
Garbage/Trash Pick -Up
Beginning Ending
Date of Date of
Contract Contract
j -7/a GLJ Li~ - P/- /7 /2-�/- /7
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.
11-Z* %crk
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