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St Lucie Countlicis "�_,07
01-08-2019
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18407(4324
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GARCIA � RIBERTO SERVICE ADDRESS h s
5405 HfC DRY DR
FORT PIERCE
FL 34982
Amount Tendered: 520.00
BDIVISIC
SU
Amount Paid:
519.00Bli. R
-ESSl-
Change Due: 1 .00
Thank You
PHONE l Z
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User'ID: MURRAYA
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This _x.request and authorizes the Thlity to render water and/or sewage disposal
services to the
rates,
ApplicantY ATERAI; Hiles and regulations,which by reference are made`a part of-flus contract V
a
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the Utility _promptly for such services in accordance with the established
rules,.and.,,,regulations'
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CUSTOMER
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SIC -F ID.
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NAME OF SPOUSEr
�S 0 XtSOCIAL,
- P _U
OF CE USE ONLY x
RECEIVED
CASH CHK# CE -By_
DATE
RECEIVED E
IV
E
D
JAN: 2919
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