HomeMy WebLinkAboutProducts Review ST LUCIE C/OU�NTY UTILITIES/'P O�BOX 728 F:T.PIERCE FL34982''.
NAME �i(/i��� (�,•. (3,4,x/
St. Lucie County PCIS
01-13-2016 01 :12:34 RECEI'. .-D JAN
16038//3963
GAYLOG WwILLIAM i SERVICE ADDRESS / S.' r r:
5215 BfRCH DR � r
FORT PIERCE
FL 34982
Amount Tendered: 519.00 i SUBDIVISIQN
�BI.00K J.
Amount Paid: 519.00
Change Due:
0.00 x �
Thank You
i.
Pxo1vE#r r` /� fir// D
User ID: WARM J 3 a i MOVE IN/CLOSING DATE
4 ;This apphcat�on..hereby equest and autlor;zes the Utihty to render waterand/or sewage disposal
,,, ,,, „� I•
'se to the.premises_described-aabov6-in acc6'r'n, e'with the;Uhhhes.present,or,future rates;
LA rules and regulations,which by reference are made a part'of this contract Apphcant agrees'fo pay:
$ ' ahe Utility promptly for.such services in:accordance with the established:°rules:and regulations:
-' �r CTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE
CUSTOMER _ SOCIAL SEC/
SIGNATURE 4
FED ID"'..
NAME OF SPOUSE r SPOUSE SOCIAL`SEC
OFFICYUSE ONLY 4
, DATE;RECEIVED f CASH:, CHK# RECEIVED BY f