HomeMy WebLinkAbout102 HAMMOND CTExemption year: 07(l / q
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Applicant's Name:
Billing Address:
Date
tried
/(02
J4.2ephone No.
Address of Exemption: // // If / /
Water Works Account No.:
/(J 6/ 53 -j1 / 97a
I request an exemption from Garbage Fees during e/curre• Ca -ndar Year. I
employ the services of a licensed trash hauler. Only t•e1 o ,tion where the
trash hauler picks up garbage and trash will q.allfy fexemption.
Applicant
s Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
(!)boYi VA Company Name O-
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
stomer's Name Garbage/Trash Pick -Up
/oa th,oi_
Beginning Ending
Date of Date of
Co tract Contrac
42,4/ ,9
RACT 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
during the current calendar year, we hereby agree to notify the
Office of this event by callin91-4323.
9
Date
647
Comparay'Addre s s
//
company
Clerk's
Company Representative
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