Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

May 2021 Citywide Clean Out Month Voucher Request Form

  1. May 2021 Citywide Clean Out Month Voucher Request Form
    Please note, only one voucher is available per household.
  2. Dacono, CO 80514
  3. Please note the following:
  4. Requested vouchers will be mailed out to residents beginning on Friday, April 23rd, 2021 through Friday, May 14th, 2021.
  5. Vouchers requested after Friday, May 14th, 2021 through Monday, May 31st, 2021 at 5:00pm will be available for pick up at the Dacono Police Department during normal operating hours (8:00am-5:00pm.)
  6. Important Note:
    Please allow one (1) business day for staff to process voucher requests if picking up at the Police Department. For example, if voucher is requested on Tuesday afternoon it will be available for pick up on Wednesday afternoon. Vouchers requested on Friday will be available on Monday.
  7. A drive through event to pick up vouchers will also be held on Saturday, May 22nd from 10:00am-2:00pm in the church parking lot beside Dacono City Hall.
  8. OUR GENEROUS CORPORATE PARTNER, STERICYCLE, is once again sponsoring the event this year. Given the many local families experiencing hardships during this time, we ask for your generosity in supporting local community agencies such as the Carbon Valley Help Center or Weld Food Bank. We will not accept donations of canned goods or other items left at Dacono City Hall.
  9. Contact information for local community agencies:
  10. Carbon Valley Help Center
    150 Buchanan Ave P.O. Box 508 Firestone, CO 80520 303-833-6626 https://www.carbonvalleyhelpcenter.org/
  11. Weld Food Bank
    1108 H Street Greeley, CO 80631 970-356-2199 https://weldfoodbank.org/
  12. Leave This Blank:

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