HomeMy WebLinkAboutPayment SlipWATER
COMM
SEW78R
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RES
MIF
IRR
SECURrrY.DEP
SERVICE FEE
SAW DAY FEE
OVERTHAE. FEE
METERINSTALE-
CFOWATER
0
FPUA CFC
CFCfSEWER
GUAR. REV..
LATERAL
—TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
DATE RECEIVED
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SERVICE ADDRESS 1� 0 W VN C.
SUBDIVISION(Dv)P_�&Z LOT_ 13LOCK_jR
BILUNG ADDRESS
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PHONH AJ) — 34 1 CQIEI� MOVE INICLOSING WaF
This. qplication.hereby request and awhodim the -Utility to tender water anw.or somga disposal
s M futur es,
emces to. the premiss &szribed above in witkthe-Utilitiespresent or a -rat
rules: and regalitions, which by refiTence, are made apart of this contract Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules. and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLF-
SOMILSECI
FED M
SPOUSE SOCIAL SEC. 67AV- -C — 9'2� '_ I•
USE ONLY
CHK# RECEIVED 13-;
Payme!nt Slip
CUSTOMER ACCOUNT NUMBER
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Type C.C.
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AMOUNT
$ 3T-1
Zip Code
Max Amount
$