HomeMy WebLinkAbout5404 KIMBALLExemption year: 2 (2e5
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
Date
Applicant's Name:
Billing Address:
Address of Exemption:
Telephone No.,3/q .239-7WO
S-yo ( m G% i4) - Jac so 70/
q, , ma-iX (VatS'U70/
Water Works Account No.: / a 7 /S/ - Sag 3S4'
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:
(We) boa_ 1A-0b.kc--
Company Name
a licensed trash hauler in the City of Waterloo,
garbage and refuse at the following location:
Address Location of
Customer's Name Garbage/Trash Pick -Up
/ ./`7 C5oe/,7!
hereby declare that we are
Iowa,
and that we pick up
Beginning
Date of
Contract
�- t - a�
Ending
Date of
Contract
1a-31—aCe
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
during
Office
event that the above person discontinues service with said company
the current calendar year, we hereby agree to notify the Clerk's
of this event by calling 291-4323.
tal o-1 as
Date
PLEASE RETURN TO:
50y;r0L, R.. k be1
Signore of Authorized Company Representative
e a..rfrJorn '(a-.) e c.,30LA.e.rtelo .ma_So713
Company's Address
((
Garbage & Trash Hauler's Permit License
(issued by Black Hawk County)
CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 50703
City Clerk's Copy - white Customer's Copy - yellow