<p> CITY OF SYRACUSE END-OF-SEMESTER UNIVERSITY AREA RESIDENTIAL TRASH COLLECTION PROGRAM Please return this form to: Department of Public Works FORMS MUST BE RECEIVED BY Attn: University Area Residential Trash Collection Program DPW NO LATER THAN MAY 11th. 1200 Canal Street Syracuse, New York 13210</p><p>REGISTRATION FORM</p><p>Instructions: Please complete this form – do not leave any fields blank – failure to fill out each field might prevent you from being able to opt-in to the special trash collection program. You must fill out a form for each property you wish to register. Please print clearly. You must pay the $225.00 “opt-in” fee by check (made payable to “Commissioner of Finance”). Participation in this program is voluntary. As a property owner, you are not required to participate. If you anticipate having extra-large set-outs, you must call the Department of Public Works to arrange special pick-ups even if you participate in this program. If you do not opt-in to this special program any and all illegal set-outs (early set-outs, extra-large set-outs, for example) will be cited by the Division of Code Enforcement. You will be subject to a fine of $225.00 for each illegal set-out.</p><p>THIS PROGRAM ENDS MAY 25th! All illegal set-outs placed at the curb after May 25th will be cited by the Division of Code Enforcement. You could be fined $225.00 for each occurrence.</p><p>Property Address: ______</p><p>Owner’s Name: ______</p><p>Owner’s Physical Address: ______House Number and Street – No PO Boxes ______City, State and Zip Code Owner’s Phone Number: ______</p><p>If you are an out-of-town landlord please provide your Property Manager’s contact info:</p><p>Property Manager’s Name: ______</p><p>Property Manager’s Address: ______</p><p>Property Manager’s Phone Number: ______By signing below, I consent to be charged a one-time fee of $225.00 for the period of May 15th-25th, 2017 by the City of Syracuse as part of the End-of-Semester University Area Residential Trash Collection Program. I understand that by participating in this program, I am not relieved of my duties and responsibilities to otherwise maintain my property in accordance with State and Local codes. I understand that this program pertains only to the volume of trash/waste that will be collected by the City of Syracuse Department of Public Works from my property during this time period.</p><p>Owner’s Signature: ______For Official Use Only: Received By: ______Date: ______Checks should be made payable to “Commissioner of Finance” Date: ______Check enclosed: Yes / No</p>