HomeMy WebLinkAboutSLC Utilities ReceiptaO Y
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0-M OF SPOUSE
SPOUSE SOCIAL SEC,
OFFICE tm ONLY
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WATER
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L'U C TY - P.O. BOX 728 . PIEBC FL 34982
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URITY DEW?
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SERVICE
SAME DAY FEE
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GUAR REV,
Pp . Y W or sewage disposal
amn4ces to t6o premise descn'bed above is accordance with the 'as present or future rates,
LATERAL
rules and regu*ous; which by reference are made a put of this contract lica�nt agrees to pay �.
S G
TOTAL.
The Utility promptly for such services in accordance ivith the astabliahad as and regulations.
CUST-
OMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
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SOCIAL 3$C! ,
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NAME OF SPOUSE
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED
CASH CHK #: RECEIVED BY