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'(� ST LETCIE COUNTY UTILITIES P O BOX 728,FT PIERCE.FL 34982
NAME �.t u O `L?t'Y1 :
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0013 t St3BDMSION j u j f LUT - BLOCK i
00123
C'38i BILLING ADDRESS
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U� izcatton hereb r uq-and'authonzes the Utilt to render water andl f sewa a dis gsaI '
PP Yi tY 8 P-
i sergices'to the, described above m.accardance with the Utllihes.present or future rates;
rotes and regutahoris,which by reference are,made a part of:this contract APphcant agrees to pay
the Uhlety promptly for such services m accordance with the established rules and regulahop5.,
CUSTOMERS DEPOSITS'ARE NON NEGOTIABLE OR(TRANSFERABI;E
SOCIAL !_Y
1 "_
1.. FED M
j SPOUSE SOCIAL SEC.:
FFICE USE ONLY
DATE RECEIVED 1�.� .1 SASi —G - UkK^# tl ' RECEIVED BY
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