HomeMy WebLinkAbout3608, 3619 , 3633, 3649, 3650 PHEASANT LANEExemption year: 46
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
Address of Exemption:
Water Works Account No.:
19160,0/04.461/40
36iq PEtia *.te, /'ice
j‘ 33 << 4#-/_/a
Telephone No,V943,3-7366
3b e g-- £W A'ev Of
J
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.
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
L
I\tie En I/14Q-1
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)
Customer's Name
PIieasa n+" /Meadows
hereby declare that we are
Address Location of
Garbage/Trash Pick -Up
309, 36,33, 3 Co4
1�� pl•,Pasar t La r,P1
C O CONTRACT PERIOD MUST COVER AT LEAST CURRENT
Beginning Ending
Date of Date of
Contract ro- r,ra t
I -)- o!7 Ia-31- ao50
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 Ihave 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
ftAfP) aj2.4.1zggiyi
Signature of Authorized empany Representative
1rc� 1J(Ivihaw� PI , 00_)-er/oO
Company's Address
0
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: RO_
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
i 12y122.
Applicant's Name:
Billing Address:
36,Q pdr. ,r-r,•
Address of Exemption: a � /1 '
Water Works Account No.r
Telephone No7 v.3"l.Q6
3608-JA0 14, OfPx.e,
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.
`''-.i
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) f. CrlVirp}`friP1,i4GL.I 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:
Customer's j
's �3lm�
�" J1eci;anr !n'I
1faCI Lt;
Address Location of
Garbace/Trash/ Pick -Up
3�r0d— 3[1(.�.�507
p1fCL l Y)t 1-cr_YiP�
Beginning Ending
Date of Date of
Contract Contract
/ l I2 7 1213 I/ 2:2_
C °''ATRACT 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 far 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 - L/ - O�?�
Date
r f 1
Signature of Authorxz d ompany Representative
Ito D (1 s7 kG. I i P 14 jQ-+e r/ o O
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