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ST. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT. PIERCE FL 34982
SEWER RES h `'1—
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METER SZ. MIF ACCT. #
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SECURITY DEP SERVICE ADDRESS.(j iX tlC�i
SERVICE FEE �"f .� (L-� 'I �� (� C ,� 1 '( CI `y �/ (J c7�1
SAME DAY FEE (((�
SUBDIVISION F1 . #"l. Q-Sh0b2,,V LOT q" l� BLOCK
OVERTIME FEE
l L) METER INSTALL. BILLING ADDRESS' , A M -
P CFC/WATER
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J FPUA CFC ]'HONE # �'P� ` l Ji r� 1 ' trL� +- MOVE IN/CLOSING DATE q
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1 J�J GUAR REV. This application hereby request and authorizes 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 a part of this contract. Applicant agrees to pay
z4 ^� the Utility promptly for such services in accordance with the established rules and regulations.
�'�� '`T J� TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
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CUSTOMER ---I SOCIAL SECh
SIGNATURE �C� ! (�✓C� 'FED -ID. —
NAME OF SPOUSE
DATE RECEIVED
St, Lucie Count yy - "'
08-13-2014 09:38:10
12814[6016
ALLISON, UUAVID
2415 ATLANTIC BEACH BLVD
FORT PIERCE
FL 34949
Amount Tendered: 4,404.00
Amount Paid: 4,404.00
Change Due: 0.00
Thank You
User ID: WARDD
SPOUSE SOCIAL
OFFICE USE ONLY
d `1 CASH GHK-'9
,
RECEIVED BY i7,� / LI& 1
51 2300EUIRSINRIAUE 6F
FORT PIERCE, FL 34982
TERMINAL ID: 1,1114111
MERCHANT N: 42516,443997
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#xxxxxxxxxxxx5250
SALE BATCH: 006946 IHUGICE:046548
GATE: AUG 13, 14 AUTH NO: 47171P
S8: 002
TOTAL $4404.80
CUSTOMER COPY