HomeMy WebLinkAboutSLC Utilities ReceiptXWATER COMM
SEWER RES
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NAME
ACCT. #
S.
SERVICE ADDRESS D /
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3 1-5'
SUBDIVISION—\����LOT3C) BLOCK C>
CtPHONE #_ — — —
MOVE IN/CLOSING DATE
This application hereby request and author&s 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_ NEGOTLABLE OR TRANSFERABLE,
CUSTOMER
SIGNATURE
NAME OF SPOUSE
SOCIAL SEC!
FED 10D
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK #