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ST. LUCIE COUNTY UTILITIES - P.O.004 728, FT. PIERCE, FL 34982
NAMEGregory'Scott Wilken and Patricia Wilken
ACCT. # i t
SERVICEADDREss6017 Buchanan Drive, Fort Pierce, FL 34982
SUBDIVISION Indian River Estates LOT67, 68 & BLOCK6
BILLING ADDRESs601 7 Buchanan Drive, Fort Pierce, FL 34982
EMAIL ADDRESS: Dwilkenpgunster.com
PHONE # 772-528-8274 MOVE IN/CLOSING DATE 1996
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,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
Utility promptly for such services in accordance with the established rules -and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE SOCIAL SEC/FED ID 266"47-7577
NAME OF SPOUSE atri id U Cen SPOUSE SOCIAL SEC. 047-60-4178
OFFICE U�E ONLY
I
E. -�
DATE RECEIVED_ 2 CASH CHK # RECEIVED BY