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COMM ST.LUCIE CUUNTY!UTILITIES-P.O.BOX-728 FT.PIERCE FL 34982
RES NAME '°' (�•'� C C [' /. x
�G M/F
IRR ACCT.#
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SECURITY DEP SERVICE ADDRESS Ir'' `1 CJ �`� `t:. t '.1�' �� i
i SERVICE FEE
SAME DAY FEE '
r SUBDIVISION I '•���. �u LOT BLOCK
E
OVERTIME FE
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LBILLING ADDRESS .� - -/ / l°�- -
METER INSTALL. `
9
y2 6
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FPUA CFC C c
t PHONE# �_S 7 - L/ �J 1GIOVE IN/CLOSING DATE
CFC/SEWER -- - - - - - - -- - - -- - -
GUAR.REV. This application hereby'request and authorizes the Utility to render water and/or sewage disposal
services to the premises;described'above in accordance with the Utilities present or future rates,.-,;{
{ C LATERAL rules and regulations,which,by reference are made�a part,o6his Applicant agrees to pay
the Utility promptly for such.services in accordance with the established rules and regulations
i $ - TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE I k
t CUSTOMS fr �---- i $SOCIAL SES
SIGNATURE (`"� FED iD � q a I.a LD
NAME OF SPOUSE SPOUSE SOCIAL SEC i
t O I SErONLY
DATE IVED 1 \ CAS CHK#
RECERECEIVED BY .