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ST.LUCIE COUNTY UTILITIES.=P.O.BOX 728,1Z PIERCE;FL 34982;
SEVER, i RES
J NAME. > +, 1�f l\ •. 1 I ('���;�j.�.,
METER SZ. M/F; � r
ACCT.# 4 C1
IRR ^ 1
$ • 00.. SECURITY DEP, iSERVICE ADDRESS iI1 '��,(.(
SERVICE FEE
SAME,DAY FEE
SUBDIVISION1 .
1� LOT _BLOCK ` -
OVERTIME FEE
l BILLING ADDRESS
L
i l r_O 0 METER INSTALL.
CFC/WATER
FPUA CFC PHONE
�"��`� S, 7 Z� MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorizes 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
the Utility promptly for such-services in accordance with the established rules and regulations.
$ ✓ TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC/ I
SIGNATURE,',-. /��'if�i�d '__ _ 1 t i :� r1 FED ID_
NAME OF SPOUSE = 'J 1 j .. C4;' t ( 7_ SPOUSE SOCIAL SEC. r 1 -
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OFFICE USE ONLY
TIATC DL•!�L`T[7L`Tl ! ,? 'i t 1 nA OTT