172-26 Attachment.pdf

TOWNSHIP OF WEST ORANGE 60 MAINSTREET, WEST ORANGE, Nd, 07032 ADMINISTRATION AND FINANCE ROBERY D. PARISI ‘Tels (973) 325-4070 Mayor . Fax: (973) 746-9182 Bmail: JGross@wartorange.org, JOHN O. GROSS, MBA. CAVLEO, Www, Westorangeorg Director of Finance Chief Pinenolal Officer an En pp eR % APPLICATION FOR REIMBURSEMENT FOR GARBAGE AND REFUSE COLLECTION COSTS PURSUANT TO-GHAPTBR 1%, OF THE REVISED GENERAL ORDINANCES OF THE TOWNSHIP OF WEST ORANGE (PLEASE-TYPE OR PRINT) named 20% Main Ge pte. 2 TRIGPHONG NuMBER: G22 BSS B93. srazeraopness:, 200° 40% bein Sh. twas Cranes, NI erpos sioons fet vor Lod (FOR WHICH REIMBURSEMENT IS SOUGHT) . NAMEOEASSCCATION OR daQUP ob BOS Atyiy Bf Lt Abita. (B2F .. ANGorunTs_2P NAN DEPIRNERRORTDING BERIOR: IM Be rent” presehrderuakconeetiontosts: EP FH Be es, oi, > 10, SERVIEE PAYMENTS MADE BY ()INBIMDUAL. () ASSOCIATION f}oTHER tspeciry) Mau fo. 1, TOTALAMOUNT OF REIMBUageMENT soUGHT,..6. 44 e 42, PERIOD FOR WHICH REIBMURSEMENT ¢soucHT:, JwrNery “ody Dee. doo 73, ENCLOSE COPIES OF-ALL BILLS FOR WHICH REIMBURSEMENT IS SOUGHT, PLEASE SHOW NUMBER OF UNITS BEING COLLECTED FOR EACH. PERIOD 414, COPY.OF SERVICE-AGREEMENT OR CONTACT: BY: -ADPLICANTS CERTIFICATION loertify that the:foregeing statements and Information are truz-to tha best of my knowledge avd belief lam aware that is any af the foregoing 1s willfully false, | ari. subjaal te puniehnigat La Shoes tits Poca ust Tiel Hseroaras., 4-998" PABASH RETURN APPLICATIONAND COPIES-OF BIL s 4o: JOHN G, GROSS CHIEF PINANC AL @PRICER TOWNSHIP.OF WEST ORANGE 65 MAIN STREET “WEST-ORANGE, NJ 07082 (BELOW FOR OFFICIAL USE. ONLY) APPROVAL: Chief Financlal Officer