3.6. SR 12-21-2009 - Laserfiche WebLink

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City of Elk River 2010 Recycling Rebate Application Form The purpose of this rebate is to reward those of you who will be or have been recycling this year. The City of Elk River's recycling rate has dropped to an average of 57% from 59%. Thank you for your continued participation in the City's curbside recycling program! With your help, we can retrieve our high rate, continue to lead the State's recycling rate by example, and minimize the City's dependency on incineration and landfills. To qualify for the $25 recycling rebate, you must complete the entire application including your utility account number and sign it. An additional $15 rebate will be given to all those residents who also participate in the Source Separated Organics (SSO) Program from February 1, 2010 -December 31, 2010. Beginning in 2011, the additional rebate will be available for those who participate in the SSO program for the entire year. Applicant Name: ' Please print your street address: Utilities Account.# (required for reimbursement):, Phone number: ( ) 1) Do you agree to recycle or have you recycled at least four materials every month this year? Yes^ No^ 2) Please circle below at least 4 materials you will be or have been recycling this year. Glass Newspaper Office paper/junk mail Aluminum/Cans MetaliTin Cans Cardboard Plastic Other 3) Do you participate in the Source Separated Organics Program at your residence? (Must participate from February 1, 2010 -December 31, 2010 to qualify) Yes ^ No ^ Appucant~s cert~tication By my signature below, and as the applicant for this recycling rebate, I fully understand that only one application per household is eligible. As the applicant for this recycling rebate, I fully understand I must be at least 18 years of age and I have agreed to recycle on a regular monthly basis at the address listed above. I understand the City of Elk River will be verifying all applications and my garbage hauler will be verifying my recycling activities. Any false information provided in this application, can, and may be punished as allowed by law. Property Owner Signature Date Mail your application to: City of Elk River, Attention: Recycling Rebate Program, 13065 Orono Parkway, Elk River, MN 55330 DUE BY: Oct 16t", 2010 For City Use Only o $25 Recyclables only o $15 SSO only o $40 Both Recyclables and SSO Clip and Save the Portion Below for Your Records ------------------------------------------------------------ Receipt: On (date), I mailed the application for a recycling rebate to the City of Elk River because I recycled (or will recycle) a minimum of four items at my residence in 2010. Businesses do NOT qualify for the rebate. Please note: The City of Elk River will contact the applicant if qualification criteria have NOT been met. If a recycling rebate is due to the applicant, it will be noted as a $25.00 credit (rebate) on the Utility Bill. An additional $15 credit will be applied as a credit if the applicant has participated in the Source Separated Organics (SSO) Program for the entire year. This credit will be noted on the January or February, 2011 bill. If the credit does not appear on the bill, this receipt is required to receive reimbursement to qualified individuals.