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01. oif Rose'ville <br />Finance, Dielpar�tment, License Division <br />A26160 Chic Center, Drive,, Rose.111 , *7VIN .4*110,05113 <br />(6112) 490 -2 ) 12 <br />411 Mi <br />Recycling Contractor, License Application <br />r <br />Fee Du�e: S'125'.,00 Year 0-.Icclisc " i I, I bc I'Or Januarx 1 10 1 )eceni bier <br />A;k <br />Business Narne f Ae' VIM <br />AA <br />HUSli fly essAddress, ' .� _ ! Okoe- <br />Contact Person Business Phoille <br />If completed ficense should be mailed soimei% he re other than the husines address, plea�s e, -.,kd% ise. <br />RecN.C11no scrvi I c'es, Nik 111, 1 be prov' ided to, (check, -tl 1 th4at ittpp INI i <br />Residential k Coniniercial <br />u fi U11, I\ 6 <br />il, I t I E I <br />Number ol"vehicies the applicant proPOIFNICS t0i LIS,C ill tile' collection of rcc c I it hil CS <br />Name and address, ()ifconipianies where recyclables, xvill he niarketed- <br />11 <br />VoIA N[IP-11111 7, IN <br />I have been provided with a copy of the C itv ot'Rosevi Ile Curbside Recvcl in. ordinance w. at lable at <br />i.rnsevilie. non .us /admin/citN-coide!ch4 -')1.txt) and understand that violation ofan\- of the prox is'0111ti <br />included in the ordinance maV result in suspension or revoicatin of the license. <br />I have attached a certificate offiabilitv insurance. a certificate indica,tina %Vorker Compensation cm crage. <br />and the fee of S 125 ).00. <br />111a, I <br />Applicant's Si!!nalure <br />