Township Council Meeting — Packet

TOWNSHIP OF WEST ORANGE 66 MAIN STREET, WEST ORANGE, NJ. 07052 ADMINISTRATION AND FINANCE SUSAN McCARTNEY Tel: (973) 325-4070 Mayor Fax: (973) 736-9182 : E-mail: jditinvak @westorenge,org JOHN C. DITINYAXK, C.M.F.O. www, westorange.org Chief Financial Officer APPLICATION FOR REIMBURSEMENT FOR GARBAGE AND REFUSE COLLECTION COSTS PURSUANT TO CHAPTER 14 OF THE REVISED GENERAL ORDINANCES OF THE TOWNSHIP OF WEST ORANGE (PLEASE TYPE OR PRINT) a. name: SO" Sely Main St Lew 2. TELEPHONE NuMBER: TA 3567 O873 3, STREET ADDRESS: SCO-3eb f4ginst |W-Ovanee MT O7052~ 4, stocdiYsO) Lot:_{.0f (FOR WHICH REIMBURSEMENTIS Sunt) 5, NAME OF ASSOCIATION OR GROUP: 30O73dle Maia SE Loe 6. anprrss: £0. Box 297257 Bernr kn, wY #224 7,wo. ofunis 27 8. NAME OF FIRM PROVIDING SERVICE: Axes tage: 9. PRESENT REFUSE COLLECTION COSTS: tilys pe? (WEEKLY, wonrheani > 40, SERVICE PAYMENTS MADE BY {) INDIVIDUAL {) ASSOCIATION J{OTHER (SPECIFY) —Mayegetueat: © 11. TOTAL AMOUNT OF REIMBURSEMENT SOUGHT: 4 I sso°° 42, PERIOD FOR WHICH REIBMURSEMENT (S SOUGHT: TJan2zS—Qee As 13. ENCLOSE COPIES OF ALL BILLS FOR WHICH REIMBURSEMENT IS SOUGHT, PLEASE SHOW NUMBER OF UNITS BEING COLLECTED FOR EACH PERIOD 44, COPY OF SERVICE AGREEMENT OR CONTACT. APPLICANT'S CERTIFICATION I certify that the foregolng statements and Information are true to the best of my knowledge and ballef. | am aware that i of the foregoing is willfully false, | am subject to puntshment BY Zs afin TITLE: Ale DATE: 6 25-26 PLEASE RETURN APPLICATION AND COPIES OF BILLS TO: SOHN C, DITINYAK CHIEF FINANCIAL OFFICER TOWNSHIP OF WEST ORANGE 66 MAIN STREET WEST ORANGE, NJ 07052 ao (BELOW FOR GEBICIAL USE ONT?) APPROVAL: Chief Financial Officer