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Acknowledgement of Mowing
By signing below, I acknowledge that the property listed on the other side of this
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form has been mowed 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
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city hall.
I also acknowledge that I was contracted by the City of Blair to mow 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 a— � � City of Blair Accounting Code: 01- 019 -5261
Name (printed) C v
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Company Name (printed)
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Address (printed)
Signature 84
SXomplaintsNowing -Sign Fost\Authorization to Mow Form.docx Updated 5/28/2013
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