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APR 13 2016
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------- stLucie_C-ounty,-FL.
ST LUCIE COUNTY UTILITIES P.O.BOX:728,FT PIERCE,FL 34982
I N;�iE 1 C�S �C ,�l��
5t. Lucie iCounty - PCIS / // I � ---
04-13-2016' 01 :09:40
AccT.# ` [lid `�
16160/4501
CASABLANCA, TERI SERVICE ADDRESS " l D / ' ►.: r7�%
5705 MYRTLE DR
FORT PIERCE C: .
FL 34982 � bfi•�-(: ��(��. � �` l
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Amount Tendered: -550.00i
SUBDIVISION LOT BLOCK (J/y
Amount Paid: 519.00
. BILLING ADDRESS
Change Due: 31 .00
Thank You
PHONE# j a"6cP " '710 C MOVE IN/CLOSING DATE
User ID: WARM
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,
L rules and regulations;which by reference are made a part of this contract.Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations..
$ : TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER n SOCIAL SEC/
SIGNATURE �J�- `�� FED II) LI'��- 01,-.'7c9 &9
NAME OF-SPOUS SPOUSE SOCIAL SEC.
jFI.55USE ONLY
DATE RECEIVED ��/� CASH CH.K# RECEIVED