HomeMy WebLinkAboutSLC UTILITIES RECEIPT''Wr WATER Comm
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SIGNATURE
NAME OF SPOUSE
DATE
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ST. LUCJE'COUNTY UTILItTIES P.O. BOX 728: FT. PIERCE FL'34982
NAME, 9: A,S...
ACCT. #'r()WO
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SERVICE ADDRESS �ot r1_ (�. OId (&A—
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#-561- / /352/ MOVE IN/CLOSING
This application hereby request and authoriies the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities precentor future rates,
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.
CUSTOMERS. DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
SOCIAL
FED ID SEC/
SPOUSE SOCIAL
CHK_
RECEIVED
SCANNED
BY
St. Lucie County
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