HomeMy WebLinkAbout314 - 320 JOHNSON ST„Dec. 18. 201 8v1 2: OOPNIx
ExEmptinn yealos
PRIVATE HAULER GARBAGE EXEMPTION AL/CATION
REMENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applioantta Name: r R 0,s= Telephone , 1/43)&11,1,0 31
}Ailing Address -17;” 4"YLj'74161 :71".0
Adds' e A A Of E,xemption: t
Water Werke A000unt Op, id '7?;11::37i1T2," ty7 plA.:11 knzt
raqueilt an examptien from Garbage Fena during tho Current Calendst Year.
employ thn services of .a licenced traeh hauler. Only rho Ioontion .whera Cha
trash haoler.picks up garbage and trash will qualify fog the exemption.
.0...4^ I
3.13
nnt's SignaturZ
TO BE COMPLETED BY LIC ED C MACE AND TRASH HAULER:
(We)
Compan
a licensed traah hauler in tha city of Waterloo, Iowa, £Ad that we pick up
garbage and refuse at the following lonotor:
hereby declare that we are
cagram/la
Address Location ot
Beginning Ending
Data of Date of
GFIrhRece./TrAgh C;aatallat
„114_ I <7 1442 ..a734/4/
CONTRACT' PERIOD JT(OVER LT LELET CUMNT CALENDAR 1ViR
We underotand that the above information is used by the Clarles Office in
Waterloo, City Hall, 715 MUlberry Streitt., to deterN,no elJ.gibl.lity fox
exemption from garbage fees t,or the current calendar yeax, 1, the
underNtghed, declare under penalty of perjury that. I have amined this
claim, including all statementa and above achedule, and to the beat of my
knowledge and belief, it is a TRUE., CORRECT AND COMPLETE, claim, and that: I
a9ree to comply with all ordinances and poliolaa of the City of. Waterloo and
the Black hawk.County Solid Waste Commiasion,
In the event that the kbove peraon discontinues borvisie with aaid company
during the current calentler year, we hereby agree to notifythe Clerk's
Office of this event by calling 2943-.5.
DetV7
41,
Siglatuns a tit prized Company Repreanntetiva
company'a iwdreue
No. 0205 P. 1uvz/0.0
JL
Gaxbge a -Tr 81 HaUlorin P0rwit La
(ilUtad by Mar:k hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE, OFFICE
715 MULBERRY STREET
WATERLOO, ION 50703
City Cirtk' Copy - white Ousromarta Copy - yellow