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HomeMy WebLinkAbout307 W LOUISE STExemption year: 2018 PRIVATE HAULER GARBAGE EXEMPTION APPLICATION RESIDENTIAL CUSTOMERS ONLY CITY OF WATERLOO, IOWA Date November 29, 2017 Applicant ' s Name : St. Paul's United Methodist Church Telephone No . 319-232-4790 Billing Address: 207 West Louise Street, Waterloo, IA 50703 Address of Exemption: 307 West Louise Street, Waterloo, IA 50703 Water Works Account No.: 4-50-0050-056205-R (parsonage) 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 *Harold Morrow, St. Paul's Trustee* TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER: (We) 1'rd'P Env;r©r)mrtnfai Tn� 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 Customer's Name 517- 10VLS C HV Address Location of Garbage/Trash Pick -Up �Q. L/, LOv2SE. ST er, ,-, ) io CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR Beginning Ending Date of Date of Contract Contract 10 )1 Z©L0 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. Dill 3 0 ►7 Signature of Authorize Company Representative ,�tro0..J4 Company's Address Garbage & 4rash 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