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ST.LUC1E COUNTY UTILITIES-P.O:,_-JX 728 FT.PIERCE FL 34982
NAME iJ k-D F
St. Lucie County - PCIS
05-19-2017 03:49:11 ACCT.# (p / `111 L J�
6787 6135 ? SERVICE ADDRESS �5 (0
D.-R. HORT�
8536 COBBLESTONE DR r rye TCg-
FORT PIERCE E
BLOCK
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FL.. 34945 SUBDIVISIONC:JLLICX LOT 1 w
E 3rj 0
Amount Tendered: 174.00 LL • BILLING D SS
Amount Paid: 174.00
Change Due: 0.00 PHONE# MOVE IN/CLOSING DATE
Thank You This application hereby request and authorises 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
User ID: RODRIGUEZM the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID 7 S a W hoa �9
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED BY
r US
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