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COMM ST LUCIE COUNTY UTILITIES-P.O.BOR 728,FT.PIERCE,FL 34982
RES
NAME .)e" AW
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ACCT.# ( p J
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SECURITY DEP SERVICE ADDRESS : 1` 0 6) �V eX a1V aA) 7)
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SERVICE FEE
SAME DAY FEE -
SUBDIVISION ' LOT C;Z' BLOCK
a' OVERTIME FEE
� BILLING ADDRESS �`-
L",/V METER INSTALL.'
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CFC/WATER
FPUA CFC PHONE# /c� " MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorizes the Utility to render water and/or sewage disposE
services to the premises described above in accordance with the Utilities present or future rate;
LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pa;
the Utility promptly for such services in accordance with the established rules and regulations
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$ TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.,
CUSTOMER ? / SOCIAL SECT fJ
SIGNATURE, I l/'"c -n `% "� -�rx-- FED ID JC
NAME OF SPOUSE SPOUSE SOCIAL SEC.
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/! OFFICE USE ONLY V DATE RECEIVEDf CASH G l SLS\ RFrFivRn D�