HomeMy WebLinkAboutUtiltiy Receipt 'ST.LUCIE COUNTY UTILITIES-P.O:y jX 728 FT.PIERCE FL 34982.
NAME Ll 1 TU •�.
St,. Lucie."County - PCIS / 1
05-19=2017 03:5O':35 i ACCT.#, O ;
6787 6129 SERVICE ADDRESS` g5 • , �+� S
c errQ
' 8501 COBBLESTONE .DR
FORT PIERCE k `
FL V 34945 SUBDIVISION " LOT _BLOCK
Amount Tendered: - 174.,00 �L,'
BILLING D SS 1
Amount' Paid: 174.00
Chance'Due: O:00 PHONE#' MOVE IN/CLOSING DATE
Thank You This application'liereby request and authoriies the Utility to fender 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: ROURIGUEZM 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
SPOUSE.SOCIAL SEC.
.._.4..._..._ ........
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED BY
i LO