HomeMy WebLinkAboutS L C UTILITIES RECEIPTXWATER —
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COMM� ST. LUCIE
a d SEWER
RES
NAME
HE METER SZ.
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SECURITYDEP SERVIGEADDRESS
SERVICE FEE
SAME DAY FEE OVERTIME FEE ., 1! r.
SUBDIVISIOtj(y
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METER INS TALL.' BILLINGADDRESS Iq --U
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MOVE IN/CLOSING DATE
- CFClSEWER
GUAR REV. This application hereby request aud'authoriies 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
TOTAL the Utility promptly for such services in, accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMER j d SOCIAL SEC/ SIGNATURE _� xAti.KA__`, ,t,�`� FED ID _ I 1 37
SPOUSE SPOUSE SOCIAL SEC. -
OFFICE USE ONLY DATE RECEIVE j it -1 CASH cm#)Y3)W RECEIVED BY ItY t
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