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W STI UCIE COUNTY UTILITIES-''P.O,BOX-728,FT.PIERCE,FL
34982
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Lucie Count - PCIS AGGT#
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1628 4912 1p SERVICE ADDRESSth✓`-�
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100 0AINTRE TR
IRT PIERCE
_ 34982
nount Tendered: 519.00 SUBTJIVISIONW LOT f BI OCK
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nount Paid: 519.00 ADDRESSd / n
LL. —v
ianse Due: 0.00 c
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l PHONE# f `f MOVE=IN/CLOSING TATE
ser ID: WARDD }
This application hereby request and authorizes the Utility to render water and/or sewage disposal,
i services to the,premises described above m accordance with the Utilities presentor future rates,
LATERAL rules and regulations,:which by reference are made apart of this:contract Appiicant agrees to pay
f the Uttlity promptly for such'services in accordance with the established rules and regulations.
TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE
CUSTOMER SOCIAL
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FED
NAME OF SPOUSE SPOUSE SOCIAL SEC. "
E'ONLY
IUS j , 1
DATE RECEIVED "J CASH CJI CHK#. RECEIVED BY '�- i_
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JUL 18 209E
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St.Lucie Cour,' 'm