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LNU VIKU11VA AR
FORT PIERCE, FL 34982
07,111/2018
12:49:26
WATER
CREDIT CARD
UN Y,uT
MC SALE
.SEWER
Card t,
XMXXXXXX7474
METER SZ,4-
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SEQ #:
Batch '
INVOICE
16
929
16
RESS
tTTF P 0 BOX 728, FT: kiiRCFt
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Approval Code: 056131
7
Entry Method: Manual
Mode: Online
I.. LOT BLOCK
Tax Amount: $0.00
A
Cust Code:
19v. �
C,�-�-�t .j /V c� , ,
Avs Code: NNN RES
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Card Code: M i
SALE AMOUNT 176.25 'x�—(,MOVE IN/CLOSING E
n h6reli y. FeqpesA andauthorizes
�tl 6!Jtility to render water and/or sewage disposal
.1 r
future rates,
alle, ith4he-:0ilities'present or f u re
'described dbove-�in accordance W
10 s `h i d6fitrict.-Applicant'agiees to pay
a "' ' ' " - -'ib�.:rei�r6n�e,ire�ma&a part of this CUSTOMER COPY 4 'i:w which
DEPOSITS �!ly� for §ti ApesAn-J.L
accordance �,wiffi%the established rules andregu ations.
S
7111� ii!—'d -NON NEGOTIABLE
Pit tz��FE
SOCIAL SE,
ER
ci
CUSTOMER
FED ID .
:SIGNA TtMW . ......
;
ME SPOUSE SPOUSE SOCIAL'SEC-.
OF
OFFICE USE
-DATE RECEVEBYDv
i
RECMEZ
MAR 8111114
PLarmitting Departmt---v
St. Lucie County