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Special Assistance Request

  1. Contact Details
  2. Address Where This Service is Requested
  3. Please confirm
    I, the undersigned claimant, do solemnly swear that I am a full-time resident at the above address; am disabled to the extent that I am incapable of moving my garbage container to the curb; and no able-bodied individual resides at the address above.

    If approved, I understand that I should not have any interaction with those collecting sanitation due to concerns over person-to-person spread.
  4. I confirm the above is true and correct.*
  5. Leave This Blank:

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