HomeMy WebLinkAboutST LUCIE COUNTY UTILITIES RECEIPTCOMM ST. LUCIE COUNTY, UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
—RES A NAME
METER,SZ. M/F
ACCT. #
IRR
SECURITyDEp SERVICE ADDRESS &V�:( (114*
SERVICE FEE
SAME DAY FEE
SUBDIVISION`a�V I&I 9-c--C- LOT BLOCK
OVERTIME FEE
� /3v.' '/o METER INSTALL.' BILLING ADDRESS X, 2'
U.�_ Al —I rill
CFC/WATER
FPUA CFC PHONE MOVE IN/CLOSING DATE
CFC/SEWER
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
the Utility promptly for such services in accordance with the established rules and regulations.
$ &0, X, tj ) TOTAL
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC/
I SIGNATURE FED ID Z54 14 3 (4
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
CEIVED, DATE RE CASH CHK#t-,,d5P00. RECEIVED BY
8 -ANNED
BY
21 Lucie County
St' Lucie CountY - PCIS
4-2
09-1 018
170%6492
RYAN HOME
5271 OAKLAND LAKE CIR LOT 60.
FORT PIERCE
FL'34951
Amount Tendered: 608.'00
Amount Paid' 608,00
Change Due'. 0..00
Thank YOU
User ID: MURRAYA
5