HomeMy WebLinkAboutUtility Receipt 1 ST.LUCIE COUNTY UTILITIES-P.O.)E,.JX 728 FT.PIERCEi FL.34982
St: Lucie County - PCIS NAME
05-19-2017 03;49:35 ACCT.
6787 6134 p SERVICE ADDRESS 1�$
D.R. HORTO (`eresz
8532 .COBBLESTONE DR f
FORT PIERCE
,FL 34945 6 SUBDIVISION C� LOT BLOCK
Amount. Tendered: 174.00 LL • BILLINGP6;L
1L4 Edo."
Amount Paid: 174.00 Its .
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 NONNEGOTIABLE OR TRANSFERABLE.
1 SOCIAL SEC/ -7 5 a o 69
FED ID
SPOUSE SOCIAL,SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED BY .
. P