HomeMy WebLinkAboutSLC UTILITIES RECEIPTt. Lucia county - PCIS
7-18-2o&�:54:17
15542(3337
?AMS HOM
S OF NOR
I" ERSTONE BLVD
IRT
P'jjRCE
. 34951
EP
aunt Tendered: 174.00
E
lunt Paid: 174.00
FEE,
loge Due: 0.00
FEE
nk You
TALL.
r ID: HURRAyA
!R
LATERAL
$
Tl�r
OTAL
CUSTOMER
7-- )
NAME OF SPOUSE
SCANNED
BY
St Lucie County
M WOO
E* FORM
ACCT. #
SERVICEADDRESS
BILLINGADDRESS
PHONE# VE INICLOS114G DATE
This. application hereby request and authodies the Utility to ierider . water andlor sewage disposal
services to the premises described above in accordance With the Utilities present or future rates,
rules and regulations, which by reference are made -a part of this contract. Applicant agree, to pay
the Utility promptly for such services in:accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERAELE.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL
DATE RECEIVED_ . CASH
7wri- . . CHK'#12t4 RECEIVED BY
1, 7-77�-- M6