HomeMy WebLinkAboutSUNNYSIDE COVE/TRENT LANEExemption year: 2-OZ60
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date December 10, 20z5
Applicant's Name:
Billing Address:
Address of Exemption:
StAnn1•S1de. Cove. 14 OA Telephone No-(s6$)2/5-0643
*See below
* See below
Water Works Account No.:
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.
0,41416
Applicant's Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) nv►ronlnticntal
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Customer's Name
S UIVIpictf. Cove HOA
CONTRACT PERIOD MUST COVER AT LEAST CURRENT CALENDAR YEAR
We
hereby declare that we are
Iowa, and that we pick up
*Trend Lane
Beginning Ending
Address Location of Date of Date of
Garbage/Trash Pick -Up Contract Contract
ItTrert% Lane., Woitrbo IA 01101224. 12/3t12o2.b
understand that the above inform
Waterloo, City Hall, 715 Mulberry
exemption from garbage fees for
undersigned, declare under penalty
claim, including all statements and
knowledge and belief, it is a TRUE,
agree to comply with all ordinances
the Black Hawk County Solid Waste Co
ation is used by the Clerk's Office in
Street, to determine eligibility for
the current calendar year. I, the
of perjury that I have examined this
above schedule, and to the best of my
CORRECT AND COMPLETE claim, and that I
and policies of the City of Waterloo and
mmission.
In the event that the above person discontinues service with said
during the current calendar year, we hereby agree to notify the
Office of this event by calli 291-4323./
/094 C 6
Date
company
Clerk's
Sian.` ure of A4thorized Company Representative
irt) /=,1/ timt>42
Company's Address
11/
Garbage & Trash
(issued by
Hauler's Permit License
Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
3007
3804
3813
381*
3815
3814,
382.
3827
City Clerk's Copy - white
Customer's Copy - yellow
gd .,;.