HomeMy WebLinkAboutSLC UTILITIES RECEIPTt. Lucie County - PCIS
1-09-2019 11:41:39
17055/6483
VAN HOMES
250 OAKLAND LAKE CIR LOT 33
ORT PIERCE
L 34951
mount Tendered: 608.00
mount Paid; 608.00
Ihanae Due: 0.00
'hank You
lser ID: RODRIGUEZM
DATE
r
ST: LUCIE COUNTY S - P.O. E
NAMEU4'1 /1Jl JL
ACCE #' 71055 - 6Wo,
SERVICE ADDRESS'
PHONE 0.SIGI 17W -/35 / MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to tender water and/or 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 agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ 5T—/39Vv
' / 2 /j
C FED ID
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SPOUSE SOCIAL SEC.
OFFICE USE ONL� /
CASH CHK RECEIVE If 13