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Application for Exemption: Residential Curbside Garbage Collection & Recycling

  1. COA logo color w text transparent.gif

  2. 1. Any person over 75 years of age that desires assistance

    2. Any person with a handicap-parking permit and with no other non-disabled or non-physically limited resident capable of transporting the cart or bin to the street

    3. Those granted special approval for assistance for reason of medical, physical, restricted strength, or other reasonable limitation

    4. Those granted special approval due to topography, scope, distance or other physical conditions

  3. Include Street, House Number, Apartment Number, etc.

  4. Are you the only resident of this household?*

  5. Reason for Exemption*

    Please choose one.

  6. If over 75 years of age, please indicate date of birth.

  7. Applicants may attach a note from a medical doctor.

  8. Leave This Blank:

  9. This field is not part of the form submission.