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City of Elk River <br />Recycling Rebate Application Form <br /> <br />The purpose of this rebate is to reward those of you who will be recycling this year. This program is funded by a MN sales <br />tax on garbage collection service. The City of Elk River has a 45% recycling rate city-wide, and with your help we can <br />maintain, or increase this rate and minimize the City's dependency on incineration and landfills. To qualify, you must <br />complete the entire application and sign it. <br /> <br />Applicant Name <br /> <br />Please :print 'your street address: <br />t Please list your phone number <br /> <br />( ) <br /> <br />1) Do you agree to recycle at least four materials every month this year? <br /> <br />Yes rq No [] ' <br /> <br />2) Please circle below ( [] ) at least 4 materials you will be recycling this year. <br /> <br />Glass Newspaper Metal/Tin Cans Cardboard <br />Office paper/junk mail Aluminum/Cans Plastic other <br /> <br />3) <br /> <br /> c:811ection ; ;;i <br /> <br />Please identify the type of service you will use to recycle. <br /> <br />Day Collected <br /> <br />Applicant's Certification <br /> <br />By my signature below, and as the applicant for this recycling rebate, I fully understand that bnty one application per <br />household is eligible. As the applicant for this recycling rebate, I fully understand I must be at least 18 years of age and I <br />have agreed to recycle on a regular monthly basis at the address listed above. I understand the City of Elk River will be <br />verifying all applications and recyclin.q activities throuqhout the city. Any false information provided in this application, can, <br />and may be punished as allowed by law. <br /> <br />Property Owner Signature <br /> <br />Date <br /> <br /> Mail your appfication to: City of Elk River, Attention: Recycling Rebate Program, 13065 Orono Parkway, Elk <br />River, MN 55330 <br /> [3 mail in white copy and keep yellow copy for your records <br /> If you qualify, you can expect a rebate sometime in January, no phone <br /> calls please! <br /> <br />DUE B Y: May '15th <br /> <br /> <br />