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ST LUCIE COUNTY UTILITIES P.O.BOX-1,28,FT.PIERCE,.FL'3.4982
RECEIVED MAR 31 C20 NAME
St. Lucie County - PCIS
03-31-2016 D1;40:41 ACCT.
16142/4074
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SERVICE ADDRESS
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500 BS
OCHDRG
FORT PIERCE IU 2.7^ I�€� � �
FL 34982
Amount Tendered: 519.00 SUBDIVISIOi4- LOT I' r O BLOCK
Amount Paid: 519.00 { BILLING ADDRESS
,
Change Due: 0.00
Thank You
MOVE IN/CLOSING_DATE
Jser ID: WARDD ,
.This application hereby request and authorizes tlie,Utilityfo render water and/or sewage disposal
services;to the,premises`described above in accordance with'”the Utilities present oe future rates,
lations,which by reference are made a part of this contract:`Applicant'agrees.to pay
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S e Utility promptly for-such services in accordance with the estabhshed'.rules and regulations.
TOTAL -CUSTOMERS DEPOSITS ARE,IVON.NEGOTIABLE-OR,TRANSFERABLE
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SIGNATUE a FED ID SEC/ ,j-1`
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NAME OF SPOUSE
1 SPOUSE SOCIAL SEC
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OFFICE,`USE ONLY If 'RECEIVED
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BY
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DATE,RECEIVE" �i SH CHK� Q. `