HomeMy WebLinkAboutSLC Utilities ReceiptWATER COMM ST. J-u C
TY UTILIT - P.O. BOX 728 . PIERCE FL 34982
SEWER �'1�'g r�
NAME 7[ ht
METER SZ. M/F
IRR ACCT # 1�« `a� CAD 0
SECURITY DEP SERVICE ADDRESS
SERVICE FEE A I f� -.II PS-7
SAME DAY FEE R�
SUBDIVISION
OVERTIME FEE
METER INSTALL. - BILLINGADDRESS
CFGWATER jqolx
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- - FPUA CPC- HONE#
MOVE
ry _ _ OVE (CLOSING DATE
CPC/SEWER A)41 N-� i�C 771it� I4T �V
GUAR. REV. This application hereby request and aut orizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
LATERAL rules and regulations, which by reference are made apart of this contract. Applicant agrees to pay
$ the Utility promptly for such services in accordan
TOTAL cc with the established rules and regulatious.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE ORTRANSFERABLE.
CUSTOMER
SIGNATURE
NAME OF SPOUSE
DATE RECEIVED
SOCIAL SEC/ 5� ^ �3CII06) / 1/
FED ID _ tD
SPOUSE SOCIAL
OFFICE USE ONLY
CASH CHK # Ja
� RECEIVED