HomeMy WebLinkAbout115 HAMMOND CTExemption year: CA2iN g
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
4
a4
/7
I request an exemption from Garbage Fees during the c rent 'glen.,: Year. I
employ the services of a licensed trash hauler. Onl the ocat;: where the
trash hauler picks up garbage and trash will qualify f• the e -mption.
Applicant's Signature
W i
ERLnr
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We)
CLERK'
pan WNaCtSA-i
Come
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 1s) Garbage/Trash Pick -Up Contract Contract
At \.1w L'c .�-i`� �,�0.1AP'X-O t 1 I i( c I2%j l l 9'
RiciEi\CONTRA T 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
f P 9: 04%dge 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 calli291-4323.
-1- L t H
Date
natu e of� Authoriz Company Representative
Company's AddrE
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