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Acknowledgement of Mowing
By signing below, I acknowledge that the property listed on the other side of this
form has been plowed by me or someone working for me; that no damage was
done to any structures located on the property; that no grass clippings or other
debris have been left on sidewalks, in the street or alleys; and that any yellow
Nuisance Violation signs put up by the city still in the yard have been returned to
city hall.
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I also acknowledge that I was contracted by the City of Blau to plow this property
for the fee listed on Line 9 on the other side of this form, and that this form
constitutes my invoice for work done on behalf of the City of Blair.
Date J / City of Blair Accounting Code: 01- 019 -5261
Name (printed) e- ex
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Company Name (printed)
Address (printed)
Signature �t ,
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S: \Complaints\Mowing -Sign Post\Authorization to Mow Form.docx Updated 5/28/2013