HomeMy WebLinkAbout1760-1746 WILLISTON AVEExemption year: 2020
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 12Be-ZO
Applicant's Name: � . LA,, Telephone Nos
Billing Address:
Address of Exemption: /---kPC) (,(2/ //'s
Water Works Account No.:
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 quali for the exemption.
Appl
ant
Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(we) 191ad4VAd hereby declare that we are
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
g arbage and refuse at the following location:
Beginning Ending
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up Contract Contract
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CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR
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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. 1, 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
t he 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
O ffice of this event by calling 291-4323.
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Date Signature of Authorized Company Representative
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Company's Address
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Exemption year: 2020
PRIVATE HAULER GAR-3AGV EXHMPTION
APPLICATION RESIDENTIAL CUSTOMERS
ONLY CITY CF WATERLOO, IOWA
Date 12/27/2019
Ap
of i cant ' s Name: Kyle Dwyer
Billing Address:
Address of Exem
1746 Williston Ave
Tele
o h o n e No. 319-826-5073
at i on :
Water Works Account No.:
1746 Williston Ave
118874-544928
I request an exemption from Garbage Fees curing 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 qu.lify for the exemption.
A
Signature
J
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
BLACK HAWK WASTE DISPOSAL hereby Declares 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:
J
Address Location of
Customer's Name Garbage/Trash Pick -Up
Beginning Endinc
Date of Date of
Contract Contract
144‘111) Tkoler /744 wrih5tek 40t, Waintioo SIf - - 2_CD 1 L l —ZU
470.2,
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.
/ ( z
Date Signature of Authorized Company Representative
Company's Address