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ST LTICIE U11uTIES DEP MM ST LUCIE COiJNTY UTILITIES-P O BOX 728,ET PIERCE,FL 3498-2
2300 VIRGINA AVE
FORT PIERCE,FL 34982 NAME 1, • f
5t. Luc; 01J22J2016 10,44,45 - ;
07-22 2 CREDIT CARD ACCT #SALE SS
" -
CVR
15E 'p SERVICE ADDREU i' t�
DIS ✓: 4i�
X1876
GRAVES', Card#
Discover Credit
49009, Chip Card: A0000001523010
FORI p AID' 0038 SUBDMSION. LOT BLOCK, { ) �
FL 34, ATC,
9DF3A1AB5115EFED `
TC; 6 BILIINGADDRESS � € t `��{ .
NNW SEQ#:
444 .`
1 Batch#: 7 t
1 NIAO INVOICE 02269R
Approval Code,. Chip Read PHONE-# + : . e �"�/T MOVE{Il�t/CLOSING DATE
Chan, Entry Method,
Issuer }`
Mode; This application hereby,request Arid authorizes the^Utihtyto render water and/or sewage disposal
Ai Trar rvices to the premises_descnbed above in accordance with the Utilit1.ies present or future rates;.
521�ZJ les and regulations,which by reference are made a part of this contract Apphcankagrees to pay
SALE AMOUNT e Utility promptly forsuch services in accordance with the established'rules and regulations;
USE iJSTOMERS DEPOSITS ARE NON NEGOTIABLE OR:TRANSFERABLE.
CU, �// SOCIAL SEC/ s
SIGH CUSTOMER COPY � 617 D
NAND, SPOUSE$OCIAL.SEC.
OFFI Y `
DATE RECEIVED - a _ CASII ..:: CHK.# RECEIVED.BY
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