HomeMy WebLinkAbout1312 TALCOTT CTExemption year:04,01 ?
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
/0 -3-ao I
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Applicant's Name • I ►') � 15 G �1 d �1/� TelephoneNG o- 9gyp �V
Billing Address: /60 35 / A .1-16 I - LA-2n/)Oc)
Address of Exemption:
/3/a. TLeorT cT (coNco PRop)
Water Works Account No.: % tj( 9 S171$(p g�
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.
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Applicant's Signature
3�9a96,/5£ 64,
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We); fe Ef)v>conl 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:
ShadewCreek C,rz:.,sin. ,-�(1o`s
Beginning Ending
d
Address Location of Date of Date of
Customer's Name Garbage/Trash Pick -Up 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 year, we hereby agree to notify the Clerk's
Office of this event by calling 291-4323.
Date Signature of Authorized Company Representative
Company's Address
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
Exemption year:01J
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date /3ldad 1
Applicant's Name:
Billing Address:
.. 19,2AS/1v/l2mi MOir TeelephonA/09A"96p-/S87`-
/�33`J ' 7;m�a //A t�/cz l�o, t,5b70/
Address of Exemption:
Water Works
/3 /a T/col} C'-F- £ t) r1 ac 5Z 7b a...
Account No .: /cal U605 j -- 5 d/5 , got.
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
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) 7�%fe &LiIianmen44
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we
garbage and refuse at the following location:
Address Location of
C stomer's Name Garbage/Trash Pick -Up
Co/ pis
l een m0n / CT
hereby declare that
we are
pick up
Beginning Ending
Date of Date of
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 year, we hereby agree to notify the Clerk's
Office of this event by calling 291-4323.
alA4A2 Pie
Date Signature of thorized Company Representative
Exemption year: C;?j1
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date 2(' ! �S
Applicant's Name:
Billing Address:
Address of Exemption:
r\fliS L/-f/1�017
Telephone No )9 a9' %
/GD 3 51111 In be f 1 402
3/ 01 TAL c d ll- Cc yr "1— LEl le- o0 1 ti
Water Works Account No.: f010 (p 5 q-S1--5.(p BoZ
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:
+Tte Cnv) con meat
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
(�nn1s zmon /3/a Yoko++ G- 3
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 year, we hereby agree to notify the Clerk's
Office of this event by calling 291-4323.
Date
Signatof Authorized Company Representative
(10N\ l91/4.0A 1 W \ o G
Company's Address
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