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ST LUCIE CZi TNTY UTIUTIES P.O BOX.728,FT.PIERCE,FL 34982
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CHALIR
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sEVIc;ODzEss PRG0R34TEE
L 92
mount Tendered: 519.00 SUBDMSION A {/a!'1,Kf �FsT, LOT BLOCK
nount Paid: 519.00
ian9e Due: 0.00
L BILLING ADDRESS
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er ID; WARDD PHONE`#i / 3 MOVE IN/CLOSING DATE
This apphcarion hereby request and auth6iizes the Utility'to render water and/or'sewage disposal
co` ane with the Utilities resent or future rates
-^ service --to the premises descnb'ed above mac rd c p ,
LATERAL ales and regulations,which by,reference are rriade a pa;t of this contract.Applicant:agtees to pay
t� the Utility promptly for such se"'w6s' in accordance with'the established-r6les.anii regulatiohs.
TOTAL CUSTOMERS DEPOSIT`S ARENON NEGt}TIABI E;OR TRANSFERABLE:
CUSTOMER .~ SOCIAL S.EC!
SIGNATURE .` FEI3.ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY.
DATE RECEIVED , CASH CHIC# RECEIVED BY