HomeMy WebLinkAboutSLC UTILITIES RECEIPTTER
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COMM I ST. LUCIE COUNTY UTI
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SERVICE ADDRESS
SERVICE FEE
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CFC/WATER
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- P.O: BOX 729. FT. I
FPUA CFC
PHONE #� � ` , � " I � _i � MOVE IN/CLOSING DATE
CFC/SEWER
GUAR. REV. Thisapplication hereby request and authoriies.the Utility to renderwater and/or rsewage disposal
services to'the Premises described above in accordance with the Utilities present: or future rates,
I - f 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. '
TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
-USTOMER / r _ S - - --- --
SOCIAL SEC/J,
iIGNATURE \'L6I,-4+<L.-, /( C�L��.�Cr.-�r� ..FED ID J / / J9 `! %r/34 J
VAME.OF SPOUSE SPOUSE SOCIAL SEC. -
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+ OFFICE USE ONLY —.
I DATE RECEIVED nst -I P CASH CHK # z I ,a I RECEIVED By""
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