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ST.LUCIE COUNTY UTILITIES•-P.O.BOX 728,FT.PIERCE,FL 34082
NAME-"- v
St. AC
Lucie County - PCIS RECEIVED AUG 03 101 s
08-03-2015 03:26:16 CT.#
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15824/4574 °"
DANIELS, JOSEPH SERVICE'5kESS"'
5303 PALM DR
FLR34982RCE ,. /
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Amount Tendered: 521 .25J
SUBDMSIOM' 1r :i-LOT� BLOCK
Amount Paid: 521 .25
Change Due: 0.00 L•
13IL-LING ADDRESS 3 f �—c l /- �/�/ ,
Thank You
User ID: WARDD :•PHONE''#' �a ��� T / MOVE IN/CLOSING DATE
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 riles 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.
`;' •r 't TOTAL. CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE..
CUSTOMER -- /. SOCIAL SECT
SIGNATUREFEDID
NAME OF SPO U E SPOUSE SOCIAL SEC.
Q OFFICE USE ONLY.. i
DATE RECEIVED U CASH BKK RECEIVED B /i`� `' d