HomeMy WebLinkAbout205 & 211 HAMMOND AVEF,xernpt.7.cn year:
2020
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
:7ES IDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 1/27/20
Applicant's Name:
First Wesleyan Church
Telephone No.319/232/1272
Billing Address: 205 & 211 Hatunond Ave. Waterloo, Iowa 50702
Address of Exemption: 205 & 211 Hanuiond Ave. Waterloo, Iowa 50702
Water Works Account No. 7-20-1190-008568 7-20-1220-008571
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
•
App1ic -nt1 s Signa use
TO BE COMPLETED BY LICENSE: GARBAGE AND TRASH HAULER:
(We)
r3POOSZO
Company Name
e
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:
Customer's Name
ckv-5\- \I\KeimA ehrth
Address Location of
Beginning Ending
Date of Date of
Ga rba e Trash Pick -Up Contract Contract
ups ktainci-v404)-ewA00 \ --act g.3\-a�
CONTRACT PERIOD MOST 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 T 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 .
Date Signature of Authorized Compan Representative
•
\•PkylpsOrf\_ &be_ w$ev 000 alA Soy 0,1
Company's Address
ill
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