HomeMy WebLinkAboutRR_5480_Summerland_DriveDocusign Envelope ID: F91144FC-DF45-47F2-9904-3FF4079EB469
Phone:
PUBLIC WORKS SANITATION DEPARTMENT
REFUND REQUEST GARBAGE/YARD WASTE
Name: 1)e v i S U V �ib c Date: [ 0 /2-312/5
Address: �!- �� 6-iklA mer 1CtVd t/e
City/State/Zip:11\f ed00 -+—C'[ 6070
Service Address: 5 $ u Stit-mM.&11-I a n
Refund Amount Requested: $ L+• a-1 **Documentation Included: Yes No
** All request for refunds required proof of payment before refunds are processed.
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Signature/Sanitation Department Date
Confirmed Refund Amount: $
a -Signed by:
Finance Signature
Confirmed w/Water Works: \s/c'es No
Refund Amount Paid: $ $4.27
11/17/2025
Date
Docusign Envelope ID: F91144FC-DF45-47F2-9904-3FF4079EB469
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Thank you for your attention to this matter.
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From dweber2401@gmail.com <dweber2401 @gmail.com>
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Docusign Envelope ID: F91144FC-DF45-47F2-9904-3FF4079EB469
WATERLOO WA
325 Sycamore Street
P.O. Box 27
Waterloo, Iowa 50704
STATEMENT OF SERVICES
Phone: (319) 232-6280
www.waterloowater.org
Page 1 of 1
Zustomer Name:
Account Number:
Service Address:
Weber Jeff & Denise
128683-504499
5480 SUMMERLAND DR
ACCOUNT SUMMARY
Billing Frequency:
Billing Date:
Billing Due Date:
Monthly
10/03/2025
10/24/2025
Waterloo Water Works Services
Water $14,39
Water Service Excise Tax $0.87
Water Works Subtotal $15,26
City of Waterloo Services
Sanitary Sewer $27.18
Storm Water Fee $5.33
Yard Waste / Recycle Curbside (old) $4.27
Yard Waste / Recycle Site Maintenance Fee $5.33
Garbage $10.67
City of Waterloo Subtotal $52.78
CI-IARGE-SUMMARY
Credits/Payments
Deposit Charged
-$130,00
$130.00
Water Works Subtotal $15,26
City of Waterloo Subtotal $52,78
Total Current Service Charges $68.04
Total Amount Due $68.04
Amount Due After 10/24/2025 $70.87
Previous Read -Date Current Read batePrevious Rea Previous Read Type..
• C•
urrent Read
Current Read Type !Jsage (CCF)
08/22/2025
08/22/2025
08/23/2025
08/23/2025
08/23/2025
09/23/2025
396
396
396
Actual
Actual
Actual
396
396
400
Actual
Actual
Actual
0
0
4
E. 4
8 2
c 2
a �
'tio-' ��' ryati' dyerya ' ryes' ' �ti, °tie: ry°rys
SPECIAL MESSAGES
Effective 1/2/2025- New office hours Monday- Friday 8AM- 4PM.
Available Online 2024 Annual Drinking Water Quality Report
https://iowaccr.org/waterloo-waterworks
Please detach and return the bottom portion with your payment. See reverse side for additional information
MAKE CHECKS;' PAYABLE TO
WATERLOO W
P.O. Box 27
Waterloo, Iowa 50704
Phone: f319) 232-6280
WORKS
ADDRESSEE:
Weber Jeff & Denise
5480 Summeriand Dr
Waterloo, IA50701
❑ Please check box if contact information requires
updating and indicate the change{s) on reverse side
Account Number:{
128683-504499
Amount Due After :
70,87
,,
Amount Enclosed:
Total Amount Due will be withdrawn from your bank
account on 10/24/2025
WATERLOO WATER WORKS
P.O. BOX 27
WATERLOO, IOWA 50704