Form MO780-1997 "Non-profit Scrap Tire Cleanup and Disposal Application" - Missouri

What Is Form MO780-1997?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2010;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-1997 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

ADVERTISEMENT
ADVERTISEMENT

Download Form MO780-1997 "Non-profit Scrap Tire Cleanup and Disposal Application" - Missouri

Download PDF

Fill PDF online

Rate (4.5 / 5) 73 votes
Page background image
MISSOURI DEPARTMENT OF NATURAL RESOURCES
FOR OFFICE USE ONLY
SOLID WASTE MANAGEMENT PROGRAM
NON-PROFIT SCRAP TIRE CLEANUP AND DISPOSAL APPLICATION
PROJECT NUMBER
APPROVAL REQUIRED BEFORE COLLECTION.
Note: Non-profit groups are the only organizations eligible to request approval to conduct a collection event(s) and seek
reimbursement for scrap tire disposal costs from this program.
To receive reimbursement you must submit the department’s Non-Profit Cleanup and Disposal Invoice (Form 780-1998).
ORGANIZATION CONTACT PERSON
ORGANIZATION NAME
OFFICIAL TITLE
ORGANIZATION ADDRESS (CITY, STATE, ZIP CODE)
E-MAIL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
FAX NUMBER WITH AREA CODE
LOCATION OF THE CLEANUP (BE SPECIFIC, INCLUDE COUNTY, CITY, BODIES OF WATER, ROADS, ETC.)
NAME AND ADDRESS OF BUSINESS WHERE TIRES WILL BE DISPOSED
ESTIMATED NUMBER OF TIRES
ESTIMATED DISPOSAL COST
APPROXIMATE COLLECTION DATE
I hereby request approval from the Missouri Department of Natural Resources to conduct a scrap tire collection event. This approval
will allow my organization to seek reimbursement for the proper disposal of scrap tires collected as part of a civic cleanup to be
conducted at the above described location. I have attached a copy of our registration with the Office of the Secretary of State stating
our non-profit status. I understand the maximum amount of money that may be reimbursed will be the actual disposal cost or $2 per
tire, whichever is less. I also understand only those tires we legally dispose of are eligible for reimbursement under this program and
written documentation must be provided to the Department of Natural Resources.
RECIPIENT AUTHORIZED SIGNATURE
DATE
TITLE
SCRAP TIRES AND ILLEGAL DUMPING UNIT CHIEF SIGNATURE
DATE
Please mail or fax completed form to:
Missouri Department of Natural Resources
Solid Waste Management Program
Scrap Tires and Illegal Dumping Unit
P.O. Box 176
Jefferson City, MO 65102
Phone 573-751-5401
Fax 573-526-3902
MO 780-1997 (11-10)
MISSOURI DEPARTMENT OF NATURAL RESOURCES
FOR OFFICE USE ONLY
SOLID WASTE MANAGEMENT PROGRAM
NON-PROFIT SCRAP TIRE CLEANUP AND DISPOSAL APPLICATION
PROJECT NUMBER
APPROVAL REQUIRED BEFORE COLLECTION.
Note: Non-profit groups are the only organizations eligible to request approval to conduct a collection event(s) and seek
reimbursement for scrap tire disposal costs from this program.
To receive reimbursement you must submit the department’s Non-Profit Cleanup and Disposal Invoice (Form 780-1998).
ORGANIZATION CONTACT PERSON
ORGANIZATION NAME
OFFICIAL TITLE
ORGANIZATION ADDRESS (CITY, STATE, ZIP CODE)
E-MAIL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
FAX NUMBER WITH AREA CODE
LOCATION OF THE CLEANUP (BE SPECIFIC, INCLUDE COUNTY, CITY, BODIES OF WATER, ROADS, ETC.)
NAME AND ADDRESS OF BUSINESS WHERE TIRES WILL BE DISPOSED
ESTIMATED NUMBER OF TIRES
ESTIMATED DISPOSAL COST
APPROXIMATE COLLECTION DATE
I hereby request approval from the Missouri Department of Natural Resources to conduct a scrap tire collection event. This approval
will allow my organization to seek reimbursement for the proper disposal of scrap tires collected as part of a civic cleanup to be
conducted at the above described location. I have attached a copy of our registration with the Office of the Secretary of State stating
our non-profit status. I understand the maximum amount of money that may be reimbursed will be the actual disposal cost or $2 per
tire, whichever is less. I also understand only those tires we legally dispose of are eligible for reimbursement under this program and
written documentation must be provided to the Department of Natural Resources.
RECIPIENT AUTHORIZED SIGNATURE
DATE
TITLE
SCRAP TIRES AND ILLEGAL DUMPING UNIT CHIEF SIGNATURE
DATE
Please mail or fax completed form to:
Missouri Department of Natural Resources
Solid Waste Management Program
Scrap Tires and Illegal Dumping Unit
P.O. Box 176
Jefferson City, MO 65102
Phone 573-751-5401
Fax 573-526-3902
MO 780-1997 (11-10)