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COMM ST.LUCIE:COUN UTIY,ITIES P O' OX 728 FT"PIERCE FL 34982
sSEWER s RES z NAME I
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METER SZ
ACCT#
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,.$= .,:; SECURITY DEP SERVICE ADDRESS � _ '�
-777
SERVICE FEE
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r SAME DAY FEE
BLOCK
UBDIdISION
OVERTIME FEE
METER INSTALL
CFC/WATER-
7
FPUA CFC ) G DATE
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IN/GLOBIN
CFC/SEWER- - .
This application hereby request and authonzest the Utility to render water and/or sewage disposal
GUAR REV services to the premises described above in accordance with the Utiht�es present oc future_rates,
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LATERAI, ru es and regula i------
which by reference are made a part of flus contract'AM 4Wagrees fo pay
y theUtiltty promptly for such serv4ices m;accordaice withtthe established rules and regulations
Q � TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE
CUSTOMER ff SOCIAL SEC/
SIGNATURE `( Uji %i„ �- FED ID J y cr 3J
NAME OF SPOUSE SPOUSE SOCIAL SEC
FSI kJSE ONLY
DATE RECEIVED ' CASH CHK# RECEIVED BY
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