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WATER COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 726 FT.PIERCE FL 34982
SEWER RES NAME 1wAf ZT6 WN
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SECURITY AEP SERVICE ADDRESS .SIU S 1?A I rI UP, 'U
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SERVICE FEE f U
SAME DAY FEE SUBDMSION LOT 33 BLOCK `f
OVERTMIE FEE METERINSTALL.' ��
Ve BILLINGADDRESS
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CFC/WATER 1:
FPUA CFC PHONE 0 `1.19 U —BOO 3
MOVE IN/CLOSING DATE
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CFCISEWER
GUAR.REV. 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 rules and regulations,which by reference arc made a part of this contract.Applicant agrees to pay
$ � /� the Utility promptly for such services in accordagce with the established rules and regulations.
( J TOTAL I CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMERM G
SOCIAL SE
SIGNATURE FED ID `t' S Y0
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NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED Ii CASH RECEIVED BY (/
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ST LUCIE UTILITIES DEP
2300 VIRGINA AVE
FORT PIERCE,FL 34982
02/11/2016 15:08:43 i
CREDIT CARD
MC SALE I I�
Card )000XX8)W0447
SEQ N:
Batch#: 15
315
INVOICE 32
11
Approval Code: 05356B
fty Melhod: Manual
Online j
Avs Code: NY2
Card Code: M I
SALE AMOUNT $521.25
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CUSTOMER COPY
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