HomeMy WebLinkAbout4535 KIMBALL AVEExemption year: fLo it
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA r
Date
Applic:ant's Name: �rM1SC E;7al �AriS�n Telephone No. 4'u i
Billing Address: 4535 IV all Ave.. WC1►t rWO .7A �D 70 +
Address of Exemption: `t53`J KlImoa(� vie, �81U10% IA L✓�� «�
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Water Works Account No.: SQ ya$o
T 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.
TO BE COPAEwJET�E[D BY LICENSED GARAAGE AND TRASH HAULER
(We) b:lote-'� 1- Ok hereby declare that we are
Comf3any Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
Address Location of
Beginning Ending
Date of Date of
C�st:c�ryg.x's dame Garbage/Trams piek_Ur� Contract Contract
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 ear, we hereby agree to notify the Clerk's
Office of this event by call'n 91-4323.
Date Jdqn4atu��e of Authorized Company Representative