HomeMy WebLinkAbout3608-3650 PHEASANT LANEALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR THEIR OWN, V
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR TF
319-529-5418
MEHMED & ZUHRA ALICAIC (Elvir, son, speaks English)
CRAIG CORY
3649 #6
RAMIZ & FAHIRA MUMINOVIC
3649 #7
HUSEIN & ISMETA BEGANOVIC
NICK GERRANS
MAGGIE A. SHONROCK
3649 #10
PAMELAANDERSEN AUG. 2017
SUVAD & VESNA MUWIC
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR THEIR OWN, WIN
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1
NAME
ADDRESS
MARVENA R.RYAN 7/14/16
3608
BRETT AND REGINATHOMPSON 6/10/19
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 THEIR OWN, WII\
Exemption year:
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date t 1Z�j22
Applicant's Name: f dgiv /fp���i�7`X".F��C6us 01'glephone No. —73U
Billing Address: :�p1/�% /n//�cF� x.. �/35���_r
Address of Exemption: A-r�AL 3 b O2 ' 3 Pt-r � ry _/Jl�V
/ .(E
Water Works Account No.: �t
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
•V c S tif— A\eAd ow5
CClA BRACT 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.
I /'n
Date
Signature f Authorized Company Representative
Company's Address
I(Q/�� I l i
Gar ag & 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