HomeMy WebLinkAboutSLC UTILITIES RECEIPT�t WATER
COMM
ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE FL 34982
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SERVICE ADDRESS
SECURITY DEP
SERVICE FEE'
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SAME DAY FEE
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CFC/WATER
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PHONE #_�11J ! t��(J '� �� MOVE'IN/CLOSING DATE
CFC/SEWER
GUAR. REV.
This application hereby request and authorises 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
Uthe
TOTAL
Utility promptly for such services in accordance �vith'the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER:
'SIGNATURE ,�
1..�-. �CC� ! f l
SOCIAL SEC/ 24
— 39 1-13 `
.C[
FED ID
NAME OF SPOUSE
.SPOUSE SOCIAL SEC.SCANNED. as
m
DATE RECEIVED :/q-/S
OFFICE USE ONLY 01 Lucie County
CASK CHK #,- DDOOO RECEIVED BY
5t, Lucie Count - PCIS
09-14-2018 61:31:00
RYANIHOME56452
5324 OAKLAND LAKE CIR LOT 17
FORT PIERCE
FL 34951
Amount Tendered: 608.00
Amount Paid: 608.00
Change Due: 0.00
Thank You
User ID: MURRAYA