HomeMy WebLinkAboutUtility Company Approval Receipt �: ' .f ry JAY F frS'a` t i.
�J� �' , t� 1 , §i � f r
\ Y, ,� �f t
!� 3 P. r - P•.
ST.,LUCIE COUNTY.UTILITIES<__P.O.BOX 728;FT£SPIERCE,FL34982
•
NAME �� �� ��� i ��
5t. Lucie Count - PCIS •t ��
11-16-2016 11 :46;41 ,,. 3g
44 ACCT # -%�®'
l 18260 5265
6MITH MAY SERVICE ADDRESS4 [,Q 11 ',-:,,•-:-.0,,,,-.•. ' .,
5208 S�UNT BLVD
=FORT PIERCE ' ' 1
L 34982
Amount Tendered: 519.00.
r
'-4. SUBDMSION LOT BLOCK
pmouht Paid:
519.00
Change Due•
0.00 BILLINGADDRESS
a e
' S 1
j1;:r.:-.,,,..1.-;:,..,...:.i',...11hank You
PHONE# MOVE IN/CLOSING DATE
;User ID, MURRAYA
3 ( a' f .,5 "
r water and/or sewage disposal
�..,, ���, , ar •�, ""� °services toathe_ remis s d scribed` bove-�in accord'ance vvitH'hhe ` `'
This a hcation hereb re uest and authorizes the Utih to rende
{ ., P � ., Utilities present or rfuture rates,
LATERAL rules•and regulations,which by reference aremade a part of flus contract Applicant agrees to pay
/ the Utility promptly for such services m accordance'with the°established rules and regulations
S = TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE- _�
CUSTOMER j SOCIAL SEC/ i
f
SIGNATURE a ( fYY4 `FED ID �
NAME OF SPOUSE N SPOUSE SOCIAL SEC K7
x OFFICE USE ONLY ! '
DATE RECEIVED���IU. f • CASH z CHK# IT S "RECEIVED BY
•. .... �v .�.. dLY... .t. l .i. .�..1n$ u� ...ti..,�,e. , Y.< �..u..L. ♦Y....r. � � i �z w£,t.,,.4...Rv7 ..,,i,•;.,....,..,...,
..i+ .a ki ...�.�.cl a.. u.. .:. �i. _.J.
4