HomeMy WebLinkAbout410-412 THOMPSON ST202‘,
Exemption year: --
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY OF WATERLOO, IOWA
7 Date De(' 1t" ip6S—
Applicant's Name: Tic" iklmof kvislAc-is Telephone No .35•PW-Slif,
Billing Address:
Ito tmt1.te.t./ -4711c, 1/4
Address of Exemption: WO - 91 14.Al1S11 AVe v--114r ‘5,
ater Works Account No.: 1000q0^ t5s
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.
App1iEant Signature
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We) Rite Environmental, Inc
Company Name
a licensed trash hauler in the City of Waterloo, Iowa, and that we pick up
garbage and refuse at the following location:
hereby declare that we are
Beginning Ending
Address Location of Date of Date of
Customer's Name GarbageL2rash Pick -CD Contract. Contract
Titan Property Investments 410 Thompson Ave 10/6/25 -
CONTRACT PERIOD MUST COVER AI 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 Cierk's
Office of this event by calling 291-4323.
12/16/2025 .
Signature of Authorized Company Representative
Date
110 Dunham PI, Waterloo, IA 50703
Company's Address
10
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