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ST LUCfE�fILITIES DEP y sT I;uclE..coUNTY UTII.ITIEs R O:BOX 7281 FT.PIERCE, L.34982 4
2300 VIRGINA AVE
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FORT PIERCE,FL 34982 NAME �v`is -al
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0811712017 f
13:47:14
CREDIT CARD ACCT'#
VISA SALE_ x F f f
)EP " SERVICE ADDRECard# SS
ChD Card: 9009
SID:
-VISA CREDIT 7
1TC: AOOOD000031010 FEE
DOOA SUBDIVISION Y LOT BLOCK
C: EE ff .
EQ#: 'ALL,"F1AEE3C717ACCZE4 IL
BLINGADDYtESS
atch#: 8
JUDICE 710 `k /P P" ✓ .:r5
)proval Code:
Method; 01417DMOVE 1NICLOSING DATE
ode: Chip Read
Issuer j This applicatiari hereby request and authorizes the Utility to"re-w1.k7water:andlor sewage disposal
n ' services to the premises described above m accordance with the Utilities present or future rates,
LEAMOUNT rules and regulations,which by re fereA are made a partof this contract Applicant agrees to pay .
��� � the Utility promptly for such services_in accordance with the established rules aad regulations: `
CUSTOMERS DEPOSITS ARE NONsol
NEGOTIABLE OR TRANSFERABLE
SOCIAL SEC/
CUSTOMER COPY '
SPOUSE SOCIAL;SEC -
, 4
DATE RECEIVED CA
CHK# RECEIVED
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RECEIV7D AUG 17 2017
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