HomeMy WebLinkAbout2610 SARATOGA DRExemption year: 02/7/ 9
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date i'—/ f
Applicant's Name: c,cJ P r Telephone No. M.Sh
Billing Address: 111 �� Yn 74 iio ufct %D'5
Address of Exemption: to/4 S / o fogo 11/� /4)0 /10,- ��,Aja .1;7 %d,2
Water Works Account No.: / 154Ci,— ...‹),j' j,j'1�
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 BY LICENSED GARAGE AND TRASH HAULER:
(We) 5JaJ< M VA(
Company 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:
Address Location of
Beginning
Date of
C stomer's Name Garbage/Trash Pick -Up Contract
0,4
0,1/7 ,2/910
CONTRACT PERIOD MUST COVER AI LEAST CURRENT CALENDAR YEAR
Ending
Date of
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
during the current calendar year, we hereby
Office of this event by calling 1-4323.
Date
at
agree
service with said company
to notify the Clerk's
re orized Company Representative
c
dress
Company's
1 /
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