HomeMy WebLinkAboutSLC UTILITIES RECEIPTI ;
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"WATER;. COMM ' ST LU,CIE CO UNTY,•UTILITIES _P.O`,BOX'728 ET..PIERGE ,FL 34982 I
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` METE � SZ M/F - ''� • r
SECURITY DEP
SERVI E'ADDRESS�'V
SERVICE FEE:
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y;; x t SUBDIVISION t `� S �.� LOT lO BLOCK
OVERTIME FEE' r
BILLING ADDRE
CFC/WATER f
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FPUA CFC PHONE;# MOVE IN/CLOSIN*G DATE
CFC/SEWER '
GUAR: REV Th1s apphcat�on hereby requestrand authorizes`the Utility to render water and/or sewage disposal
" services to the remises described above m accordance with the UEilities resent orf future rates, ;
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LATE rples and regulatiops, which by reference are made aLpart of thrs contract. Applicant agrees fo pay
promptly for such jsen+ices m accordance with the'estabhshed rules and regulaiiops.
PCUS�OMERS DEPfOSITS AREsNON�NEGOTIABLE OR TRANSFERABLE
�CUSTOMER�`} fir r E SOCIAI.SEC/
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, SIGNATURES FED ID
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NAME OF SPOUSE SPOUSE SQCIAL SEC
;RECEIi, I � lrl/..`�<.CASH, v !.r ' C '�'.' RECEIyEI� $Y .