HomeMy WebLinkAboutPHEASANT LANE CONDOSExemption year: D
PRIVATE HAULER GARBAGE EXEMPTION APPLICATION
RESIDENTIAL CUSTOMERS ONLY
CITY CF WATERLOO, IOWA
Date
/7/
Applicant's Name: Phasaia.
ikiTelephone Nc36.233.
3-6c/-0 f9Ae-- L�
Billing Address:
Address cf Exemption:
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.
App icant's Signdture
TO BE COMPLETED BY LICENSED GARBAGE AND TRASH HAULER:
(We;
R # Enkiy-onait (
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 cf
Customer's Name Garbage/Trash Pick -Up Contract Contract
toitetri-6 iveeadvo_ .36(& )494e4.414-ri //o_d
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 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 callin 9 -4323. /
Da e crgnaturE- of Ault r zed Company Representative
/29
Company' dress
Garbage & Trash Hauler's Permit License
(issued by Black Hawk County)
PLEASE RETURN TO: CITY CLERK & FINANCE OFFICE
715 MULBERRY STREET
WATERLOO, IOWA 507C3
City Clerk's Copy - white Customer's Copy - yellow
NAME
4 C. 'sfY
R PU C-IC J-IJ�E 202-2-
CORY VINDERSLEV
BRADLEY & ANNETTE YOUSSE. (12/2024)
L% die-
ZUHRA ALICAIC
CRAIG CORY
RAMIZ & FAHIRA MUMINOVIC
HAJRVDIN KUDIC. (5/8/2024)
ELVIS & SELMA ALICAJIC. JULY, 202
PAMELA ANDERSEN AUG. 2017
SUVAD & VESNA MUJIC
3649 #1
3949 #2
3649 #3
3649 #4
3649 #5
3649 #6
3649 #7
3649 #8
3649 #9
3649#10
3649 #11
3649 #12
ADDRESS
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR THEIR OWN, WIN
NAME
ADDRESS
HOWARD B. DAHL (,NOVEMBER 2017)
BONNIE MEIGHAN
& CONNIE GRAHAM
RANDY WALKER
3619 #1
3619 #2
3619 #3
3619 #4
LISA C TSCHERTER-JONES, KRISJONES/JAELON JONES
DERECK DAVISLSEPTEMBER 202(?)
LEAH ELROD, (JULY, 20244
MERIM & SADIJA RAKANOVICH%AUGUST 2020)
HARTS MUJIC (SURDA MUJIC sister) 1ARCH 202
JEREMY FRY
3619 #5
3619 #6
3619 #7
3619 #8
3619 #9
3619 #10
NURE PURIC
3619 #11
JASMIN SARIC
3619#12
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR THEIR OWN, WIND
36# 7a/zeidd,x,
cVaz7iq
NAME
ADDRESS
MARVENA R.RYAN 7/14/16
3608
BRET AND REGINA THOMPSON 06/2019
3610
BECKY SEIFRIED
3616
BETTY L. G ETTY
3618
KAREN BENEKE
3624
DIANNE RAGER
3626
,K///,6IJ •
LARA.EARNEST. /2/ O23') /`� �'; '
3632
MUHAMMAD SARWAR
3634
,
CONNIE BROELL
3640
CAROUALEB-B s, A..5-en ) )4)/:'-' ..9- ; c
3642
T
PAM DOWIE
3648
SUSAN CLARK
3650
A.
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO PAY FOR THEIR OWN, WIt
NAME
ADDRESS
CINDY DAHL HINDS
3633
#1
JERRY&JUDYANDERS r l,''
3633#2
JANET & STEVE MARICLE (/�I/3° 3
3633
#3
MIKE & ANGIE ERNST01/23/2020
3633
#4
MELISSA O'BRIEN
3633
#5
✓ e "'_ � AJIA PAJAZETOVIC / AMIR I<ENDIC /'�r1i ° '' ;
3633
#6
SARAH E. JUHL (.9/23/16)
3633
#7
OSMAN OMANOVIC
3633
#8
KADIR & ZLATA DIZDARIC ' 07/12/19)
3633
#9
BIANSE VELIC 07/2022 '
3633
#10
SEMSO ZINKA KAJTEZOVIC
3633
#11
TRAVIS & VELDINA DELK
3633
#12
ALL OWNERS WITH DATES BY THEM WILL BE EXPECTED TO
PAY FOR THEIR OWN, WIN