HomeMy WebLinkAbout3608-3650 PHEASANT LANEExemption year:
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PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date ) ) 3 1 ( Cl
Applicant's Name jc'li,5tiht jl/fl41/ca
Billing Address: •�yyf'
Address of Exemption:
Water Works Account No.:
L Telephone No 5/4�):3,-73[.`(p
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 GARBAGE AND TRASH HAULER:
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
(We)
hereby declare that we are
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
/ dAwxf%Ilx° [‘'
CONTRACT 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 company
during the current calendar year, we hereby agree to notify the Clerk's
Office of this event by calling 291-4323.
t-z5- 19
Date
Signatur of �(uthorized Company Representative
Company's Address
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
1 •
NAMES 0
NAME
ADDRESS
MARVENA R.RYAN 7/14/16 NATx
3608
SEEMA ARAB
3610
BECKY SEIFRIED
3616
BETTY L. GETTY
3618
GARY & KAREN BENEKE
3624
DIANNE RAGER
3626
GAY MCBRIDE
3632
MUHAMMAD SARWAR
3634
CONNIE BROELL
3640
CAROL WEBB
3642
PAM DOWIE
3648
SUSAN CLARK
3650
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR
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NAMES OF
ADDRESS
CINDY DAHL HINDS
JERRY & JUDY ANDERS
LINDA OLTROGGE
MARIA DEL CARMEN MARTINEZ 7/29/16
MELISSA O'BRIEN
13633 #5
JUDY STARBUCK
3633 #6
OSMAN OMANOVIC
3633ESSIZEMON
#8
113633 #10
3633 #11
SEMSO ZINKA KAJTEZOVIC
TEAVIS & VELDINA DELK
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO
3633 #12
NAME
HOWARD B. DAHL NOVEMBER 2017
BONNIE MEIGHAN
KENNETH & CONNIE GRAHAM
RANDY WALKER
TOM LIND
CHRISTINE & AARON FERRIE
TRENT FLANDERS
FEHIM PORCIC JULY 2016
LUBOMINCA BIJELIC
JEREMY FRY
NURE PURIC
JASMIN SARIC
NAMES OF
ADDRESS
3619 #1
3619 #2
3619 #3
3619 #4
3619 #5
3619#6
3619 #7
3619 #8
3619 #9
3619 #10
3619 #11
3619 #12
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR
CUFF ISRAEL
CORM VINDERSLEV ____ _' 3b49 #1
ESTHER L NEWCOMER 3949 #2 `_._- _.
FAITH HE_�`�"'----- � 3649 #3
MEHMED &ZUHRA 35
CRAI6 CO ~ALTAIC
?3649 #S
RAM
_--'__ &►SMETqBEGANOVIC
NICK GERRANS ~�
M,A�GIEA. SHONROCK--�_
PAMELA ANDERSEN
AU
SUVAD & VESNA MUJIC
NAMES OF
NAME
ADDRESS
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SER
49#4
IZ &FAHIRA MUMINOVIC 4--__ 3649 #6 _. _ I
3649 #9
(3b49 #10
G.2017 — 13—
649 #11
93649#12
ALL OWNERS WITH p _ f ._ _
ATES 8Y THEM WILL `8E EXPECTED TO p_____ FR
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