HomeMy WebLinkAboutSLC Utilities ReceiptSt. Lucie County - PCIS
11-04-2019 03:17:16
$ 15542/6897
ADAMS HOMES OF NOR
5334 SAN BENEDETTO PL LOT 11B
FORT PIERCE
FL 34951
Amount Tendered: 174.00
Amount Paid: 174.00
Change Due: 0.00
Thank You
User ID: ROORIGUEZM
C
ti
0 a E
UJ �� a
L L
w �
U
W U U
Lu m
p u
J
I -
VAME
ACCT. #
SERVICE ADDRESS
PHONE # C)�), S' ?S 3 (9 �'� / MOVE IN/CLOSING DATE
Gl.
This application hereby request and embodies the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ J 1
FED ID ' �)—.��XPt)l(G�J
SPOUSE SOCIAL SEC.
OFFICE USE ONLY /
DATE RECEIVED �l 1 `i CASH CHK # 1 �/� ��tl S RECEIVED BY