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R E C E I V E7D AUG 2 9 ?�� `ST LIJGIE COUNTY IJTILITiES P U BOX 728 FT.PIERCE FL 34982
NAME777-
77
St. Lucie County - PCIS i
08-29-2016 03:59:23 ACCT.#
SERVICEADDRESS _ v
16341/4654
CHRIETZ6ERG, WALTE .
6109 PALM OR
FORT PIERCE s
962 SUBDIVISION �..� � I:OT BLOCK
FL 34
Amount Tendered: 519.00 tL
BILLINGADDIL
RESS
" c-
Amount Paid: 519.00
PHONE�# U MOVE IN/CLQSING DA1B
Chance Due: . 0.00
This application hereby request and authorizes the V#14,.to render water and sewage disposal;:
Thank You servxees'-to the premises described above,;m accordance with the IJtylrties_present or future;rates,.`
Mules and reSulat ons,which by reference-are idea parf of this contract;Applicant agrees to pay.
e Utility prongtly for such services in accordance with the estabitshed:rules aiid regulations
User ID: ROQRIGUEZM TAMERS DEPOSITS ARE NONNEGOTIABLE Olt TRANSFERABLE
..
16
FEI7ID
l SPOUSE SOCIAL SEC
OFFICE USE ONLY
DATE RECEIVED CASH CHK# REGEIVED-BY