HomeMy WebLinkAbout207 W LOUSE STExemption year: 2020
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date December 5, 2019
Applicant' s Name : St. Paul's United Methodist Church Telephone No . 319-232 4790
Bil ling Address : 207 West Louise Street, Waterloo, IA 50703
Address of Exemption : 307 West Louise Street, Waterloo, IA 50703
Water Works Account No.: 4-50-0050-056205-R (parsonage)
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
t rash hauler picks up garbage and trash will qualify for the exemption.
9u li(n'et.A.
Apj'Jlicant's Signature *Harold Morrow, St. Paul's Trustee*
TO BE COMPLETED BY LICENSED GARBAGE ,AND TRASH HAULER:
(We) C'2V vt. ,/4L.cj 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:
Address Location of
Customer's Name Garbage/Trash Pick -Up
Beginning Ending
Date of Date of
Contract Cont ac
CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR
We understand that the above information is used by the Clerk's Office in
W aterloo, 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
during the current calendar year, we hereby agree to notify the
O ffice of this event by callin. 291-4323.
Date
company
Clerk's
Signature of A t or zed Company Re.resentative
110
Company's Address
0
Garbage & Trash Hauler's Permit License
(issued by Black Hawk County)
P LEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
City Clerk's Copy - white Customer's Copy - yellow