HomeMy WebLinkAbout1233 KNOLL AVEExemption year: 202.2
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO,.IOWA
Date
Applicant's Name: Telephone No.(31)gkb"I'936
Billing Address: p33 Ki,ct\ Ave u '/o C4 4.6-701
Address of Exemption: /,233 V a it A v viltod 00
Water Works Account No.: t, [J ,i. j5 3 717
i
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.
(1,jI t n
's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 31ea. NawK w0.2S €-- U+ o5 )1
Cpmpany Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at thefolloWing location:
Customer's Name
C,OC1/4y Sct,et\l�tvr�
Address Location of
Garbage/Trash Pick -Up
t -33 Knoll olv
hereby declare that we are,
Iowa, and that we pick Up
Beginning Ending
Date of Date of
Contract Contract
I-I-22 )2-3I-22.
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•curr'6nt 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 tp comply with all ordinances and policies of the City of Waterloo and
theBlaek Hawk County Solid Waste Commission,.
In the event that the above person ryydisccxntinues serv1ce wi€h said company
during the current calendar year, we hereby agree to notify the Clerk's
Office of this event by callg 291-4323.
3/►0/22
Date
Signature of -Authorized Company Representative r'