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265736 WHI7E - CITY CI.ERK PINK - FINANCE GITY OF SAINT PAITL COU11C11 CANARV - DEPARTMENT File NO. �� BLU.� -MAYOR � � ncil Resolution Presented By d Referred Committee: Date Out of Committee By Date WHEREAS, Emma Waller at 2155 Londtn Lane, St. Paul , Account #54339, Parcel Code 02-92250-010-07, was assessed $16.80 as a Delinquent Refuse Charge in 1974, and WHEREAS, it was determined that the wrong Parcel Code was assessed, be it . RESOLVED, that Errxna Waller be refunded $16.80 fran the So) id Waste Collection Fund. jm COUIVCILMEIV Requested by Department of: Yeas Nays Christensen Pubi ic Works #R�c Hunt In Favor Levine Rcedler B '' Sylvester Against y Daniel J. Dun rd, D recto RA Tedesco President�x NoZZa Adopted by Co Date � � rj �]� Form Approved City ttorn Cer ' P Council retary BY By Approv by Mayor: ate � f� Approv by May ub ' ' n to C ncil By By PuB��sHE� JUL � 6 t975 . . . .. .. } y^ NY . ,� �_ �:' . . .. . . .:�.• , .: .. ' , ... .�.. , t y�. . . �. .. �. . '� . . .; . t .: �. . .. . .j. :. ._� : �-' :; T` i Zt �� .. . . ,y'�� '.;� h f.� .y,� i� �i: �o �ir� .��. ��'Y .��.:;,`< - �w ? .�'31 i"�Y_ - . ' � � : .. -. i�` : _ ... , t�7'Y .i?F 5�� ,�� ` . . . . , _ , .: . , . : ,,. � . � . _ , _ . . . .. .. � . ��-�� Y �Q-i��s�t�� : - � ir�o�as �.. � . ��P�1��" T� �� NQ:�. �A��REI�CE �!K�E�� z�� ,. � t��: �lune t J, 1975 . � ; v . , ;:; , REGARDING: Cot111C11 .RC� utTtifi� to re�fnnd I�e1 fnque�t Rdfus� �sess�e�st, `5 . a�ssesaad aga��st pro�erty at 2155 l.on�i�n �.;s�e,. �5t �ond#n �� i,a,n�e �houid tha�ra been ��essad. _ IncorreGt Psr 1 Ccde was �� 1+ec�uci at time of as��ss�ent. � _ . , , . � : , _ � : St��3��:s : ��part�ent of� Pnbl?c Works � Account i ng. . � . `' . , , , _ � k ACTZON� R�QUESTE�: App�+OVe COUnctl- R�solu,Lion � ;' _ : � , _ ,�- . : �TT1�CI31!3EI�TS: Counc i l Rasol ut ton . , = ,: d�3f it�if}m . - � :; �_ , . .. . - . . . . � . . . . . . 5�. .,, . ' �. .. . . .. . . . .. � . .. .. ' ' � . . . . . . . .. . ':..:� �.'.{L . ' . . . . . . . ; :: . �. . .�. ; � �ity Nalt S�ic�t P��f, h�iin��sot� 5�.�tn2.`; , .. � ��,; . � � � � � � � , f. _ :,....�:;� . . . FIRST REPORT OF INJURY � ��s��,�N�,�. - 265`7�� 469-20-169� �Cr`j (8N Instructioos oo Rererss Sid�) o b�m�d Injury -��'(�,�.�L 6-19-75 C� `� , ITY OF SAINT PAUL mployer's Minnewts Withhoiding Tax Numbsr � 802 5U y5 ,:�/'/1 !�' � � Inwre�'s FileNo. 832025 --- -_� 7�-��„��. --- : , , t. EmptoyeeNeme (Last) Doc�ald �F'�t) �� (M.l.) ,]4-9231 ' G rant .._.__ TcI.No. - --- ` 1$21 E. Magnolia Ave., Apt. 4 __ _ � � 2. Employee's Screet Address M�nnesota � � ��T� , �ty S t. Pau 1 Stete � Zip Code - - -- 3. Binhdate 5'3�"27 Sex Mr�FQOccupation Emerqe�cY Sanitation Laborer 4. Marital status-SingisUMarried(� Separated❑ Divo�cedU 5. Type of Employment: Full-time[� Part•time❑ Sessonai[x� Volunteer❑ If other,specifY - 6. Type of work program, if applicable:Apprentice❑ GI�] If other,specify EMPLOYEE 7. Average Earnings per week $ .Check if eamings are used on piece wnrk 5 � 8. Straight time worked: Hours per day$Number of days worked per week . , 9. Average over-time workerJ: hours pe�day�Specific daysworked: M 7�111 T F S S 10. Straight•time rate:�_.��er hour.Over-time rate: $__per hour. � ' 11. If part•time worker, state total amaunt earned, total number of days worked and total number of weeks work e d in t he lar 26 weeks: $_For_Days_]Neeks. Number of houn normally wo�ked by full•time employees per week - • 12. If fumished in addition to wages,state weekly vatue of: Board $_Lodging$ N�Other$ • 13. Did employee have other regular employment at time of injury? If yes,where? 14. Employe� C i t o St, au Tel.No. _0255 �u-b i c o r s Tel:No. 15. Depertment 16. Type of ownerst�ip: Ind'+vidual(� Part�ership) Co�poration(x� Sanita`�ion Garage, 881J N. Dale St. - __ 17. Employer's address M i nnesota EMPLOYER City Sr Paul Stau Zip Code�� 18. Name of supervisor who firstteceived knowledge of injury RaY E. Horn i n _ . 19. Oate when notice was received 6'j 9'?5 Time of day injury occurred��_45J�1.M P.M. 20. Location where i�jury occurred In front of 522 E. Hoyt Ave. _ On Employer's premises (�Yes x�No. If No,state where: �1, pes�ibe claimed injury or illness in detai�and indicate the part of body affected: paint sprayed into eyes. NATURE 72. Oid claimed injury or disease cause loss of time? ��Yes ❑No First day�Of20 75 time AND EXTENT 23. Were full wages paid for last day workedT x[�Yes ❑No OF INJURY 24. Has employee retumed to work7 QYes (�No If yes,when OR 25. If injury or disease rewlted in death to employee,complete the following� Date of Death OISEASE Name of dependent or next-of�icin Address Relationship MEDICAI 26. Name of treati physician Doctor on duty - St. Paul Ramsey Tel.No. 222'4260 qNp 27. Address 64� Jackson St. Dateof Initial Visit '�9-75 HOSPITAL 28. Did employer authorize medical treatment� �x Yes []No 29. Describe how injury or death occurred specifYin9 N►hat empioyee,wa�s dping at tfie time: Running packer in on rubbish truck #5�) when spray pajnt can ex to ea. 30. Name of object(e.g., tre�ch cave•in,machine,toot,appliance,etc.)or substance(e.g.,chemical,poison.ges.radiatio�,etc.,; which caused the injury: Can of spray pa i nt. 31. Did any empbyee phYsica�handicaP contribute to cause of injury? Q Yes xQ No If yes,hoJv7 3Z,� What action has bee�taken to prevent rocurre�ceT 6-19 t s �= Si9ned bY '.�."� - DATED • WC 102, Revised Sept., 1971 Official Position Pa� rol 1 Su v. - • ,.• --�-� -�-��---,�.�e,, Te�ePho�a Phone No. 29$-4248