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ST LUCIE CO TY UTILITYES_, P:O.BOX 7 8 FT PIERCE FL' 34982
NA141E`fi
St. Lucie Count - PCIS
08-06-2015. �1:11 :12 ACCT
15831/4811
KELLY ROBERRT aERvitE ADDREss
5009 01
ITR DR
FLR3498tt2RCE
Amount Tendered: 519.00 t uBDIVIs1oN''k Loi. BLOCK .
Amount Paid: 519.00
Change Due: 0.00 /�
Thank You �, . L- :12 �/W
PHODIE`#` S aZ t� �I41OVE IN/CLOSING DATE
User ID: WARDD
This 4ppli6tiori hereby'request.itnd authorizes the Utility to reader water and/orsewage disposal
services to the premisesdescribed above in accordahct with the Utithhes present or,future`Tates;
LATERAL rules and regulations,which by reference are made a part of this contract AppLcantagrees to pay
the Utility promptly for-such sery�ces'in accordance-with the estabhsied rules and regulations;
TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE
CUSTOMER SOCIAL SEC/
SIGNATURE D
NAME-OF SPOUSE -
SPOUSE SOCIAL SEC
OFFICE:USE ONLY /.-
DATE RECEIVED (Q /: CASH CHK# RECEIVED 1 y
RECEIVED AUG 0 6 2015