HomeMy WebLinkAbout1723-1729 ROBIN RD Exemption year : 'Z�02
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO , IOWA
Date ZS /Z 1
Applicant ' s Name : w I LSoN ,ASSC'TS L. L C. Telephone No . 31y - 231 - 55't}
Billing Address : & OV ALPINE, M - .
Address of Exemption : 11 23 I �7 z�q P-o p, i N (L,:7Ap
Water Works Account No . : 3 t{ Z - �C, 8 46 S
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 .
V
App ant ' s Signature
7
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER :
( we ) e+e (nqNit Y'OVII'VLcLyfm0. ! h C. • hereby declare that we are
Company Name
a licensed trash hauler in the City of Waterloo , Iowa , and that we pick up
garbage and refuse at the following location :
Beginning Ending
Address Location of Date of Date of
Customer ' s Name Garbage/ Trash Pick - Un Contract Contract
W tk5 ? n Asp+ s LLC ma Rc;bih V�oL .5 zg l s
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 . if 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 .
3J I
Date �- Signatur Authorized Company Representative
( l 0 EXAP\ F�;tivv�. P( wa-h�r-foo +4 5003
Company ' s Address
loy,
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