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77
ST.LUCIE COUNTY UTILITIES P.O.BOX 728,FT.P`TERCE,FL 34982
l
NAME - Vt.
t. Lucre County - PCIS 1 �,
it-O6-2016 10:40:50 i ACCT
16029/4777 SERVICEADDRESS C, Q0 f i 7i BJP
4USKETT, MICHAELl
3008 PAPAYA DR
ORT PIERCE
FL 34
982 1. `SUBDIVISION: l m LOT I BLOCK
Amount Tendered: 519.00 ! BILLINGADDRESS 6-1 ZC� r
Amount Paid: 519.00
Change Due:
0.00 !. PHONE# ? Z %G 1— 7� �/ MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
Thank You services:to.the premises-described above in accordance with the Utilities present or future rates,
ules And;regulatiogs,`which by reference are made a patt of this contract:Applicant agrees to.pay
the Utility promptly for such.services in accordance with the established:rules and,regulations. .
User ID: RODRIGUE
CUSTOMERS.DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL'SEC/
FED ID
SPOUSE SOCIAL SEC.
((,^, OFFICE USE ONLY r
DATE RECEIVED . �YJ CASH CHK#� RECEIVED BY f `