Fillable HAULERS APPLICATION (TRASH REMOVAL) IF APPLICATION IS MADE (City of Plattsburgh)

Fill Online, Printable, Fillable, Blank HAULERS APPLICATION (TRASH REMOVAL) IF APPLICATION IS MADE (City of Plattsburgh) Form

Use Fill to complete blank online CITY OF PLATTSBURGH (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

HAULERS APPLICATION (TRASH REMOVAL) IF APPLICATION IS MADE (City of Plattsburgh)

On average this form takes 9 minutes to complete

The HAULERS APPLICATION (TRASH REMOVAL) IF APPLICATION IS MADE (City of Plattsburgh) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Plattsburgh

BROWSE CITY OF PLATTSBURGH (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
HAULER’S APPLICATION (TRASH REMOVAL)
INSTRUCTIONS:
IF APPLICATION IS MADE ON BEHALF OF A CORPORATION, SUCH INFORMATION SHOULD BE FURNISHED
AND THE OTHER INFORMATION SHALL REFER TO THE OPERATING MANAGER OF THE BUSINESS.
CI
TY OF PLATTSBURGH – CLINTON COUNTY, NEW YORK
APPLICATIONS FOR LICENSE TO COLLECT AND REMOVE AND/OR DISPOSE OF REFUSE IN THE CITY OF
PLATTSBURGH IN ACCORDANCE WITH SECTION 183 OF THE CODE OF THE CITY OF PLATTSBURGH.
APPLICATION IS HEREBY MADE FOR A LICENSE TO COLLECT, REMOVE, AND /OR DISPOSE OF REFUSE IN
THE CITY OF PLATTSBURGH.
CO
RPORATION NAME: __________________________________________________________________
NAME OF INDIVIDUAL: _________________________________________________________________
ADDRESS: ____________________________________________________________________________
DATE OF BIRTH: _________________ (MM-DD-YYYY)
SEX: FEMALE
HEIGHT: ______
____ WEIGHT: __________
MALE
SOCIAL SECURITY #: _______________________________
HAVE YOU EVER BEEN CONVICTED OF A CRIME: ___________
IF SO WHAT CRIME(S), DATE(S) AND ASSOCIATED CITY AND STATE:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
HOW MANY VEHICLES DO YOU USE? __________________________________
DO YOU HOLD A VALID N.Y.S. LICENSE AS PER SECTION 501 OF THE VEHICLE AND TRAFFIC LAWS OF
THE
STATE OF NEW YORK: (Y) (N)
HAS IT BEEN SUSPENDED OR REVOKED: (Y) (N)
IF SO, GIVE DATE, WHY AND WHERE( PLEASE LIST EACH OCCURRENCE SEPARATELY):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
THIS APPLICATION IS MADE FOR (MAKE OF VEHICLE):
_____________________________________________________________________________________
YEAR OF VEHICLE: _______________ VEHICLE IDENTIFICATION NUMBER: ______________________
WEIGHT CAPACITY: ______________ LICENSE NUMBER: ____________________________________
IS THIS VEHICLE PROPERLY IDENTIFIED AS PER CODE: (Y) (N)
CERTIFICATE OF INSURANCE PROVIDED: NAMING CITY OF PLATTSBURGH AS ADDITIONAL INSURED.
PUBLIC LIABILITY IN THE AMOUNT OF $1,000,000.00 FOR DAMAGES TO PROPERTY FROM ANY ONE
ACCIDENT OR INCIDENT (COMBINED SINGLE LIMIT FOR PERSONAL INJURY OR DEATH OR PROPERTY
DAMAGES) $2,000,000.00 AGGREGATE: (Y) (N)
LICENSE FEE $190.00 PER VEHICLE PER CALENDAR YEAR.
IT IS MY UNDERSTANDING THAT IF I VIOLATE ANY OF THE PROVISIONS OF THE ORDINANCE, A COPY
OF WHICH I HAVE READ OR PURCHASED, THAT I SHALL BE FINED. A SEPARATE OFFENSE SHALL BE
COMMITTED ON EACH DAY DURING OR ON WHICH A VIOLATION OCCURS OR CONTINUES.
___________________________________________________________________________________
(SIGNATURE REQUIRED)
FOR CLERK’S USE ONLY
INSURANCE CERTIFICATE REVIEWED AND ACCEPTED: (Y) (N)
PERMISSION TO ISSUE LICENCE GRANTED BY: _______________________________________________
(CITY CLERK)
LICENSE ISSUED BY:
____________________________________________________________________
(NAME)
DATE: _______________(MM-DD-YYYY)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

HAULERS APPLICATION (TRASH REMOVAL) IF APPLICATION IS MADE (City of Plattsburgh)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document