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ST.LUCIE COUNTY UTILITIES
AMEN
St. Lucie County - PCIS /
{{. 01-07-2015 02:27'55 ACCT.#
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15561/5345 !
ERVICE ADDRESS
F HOMETOWN COMMUNITY
5604 SUNSET DR
FORT PIERCE
' SUBDIVISION
FL 34982
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Amount Tendered: 520.25 IINGA DRESS
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i Amount Paid. 520.25
0.00 HONE:#
Change Due: ;
This application hereby request and
Thank You ,services to the premises described al
l rples and regulations;,which.by refer
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the Utility promptly'for>such'servic�
User ID: RODRIGUEZM CUSTOMERS'DEPOSITS ARE NO
SOCIAL SEC/
SPOU$E.S61C
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'It6MM ST.LUCIE COUNTY UTILITIES-P.O.PPX 728,FT PIERCE,FL 34982 :
SEWER 'RES
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METER SZ.
ACCT.
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SECURITYDEP, ERVICE ADDRESS
SERVICE FEE
SAMEJDAY FEE!
OVERT!
SUBDIVISION -LOT BLOCK
AI?
'IME FEE
7��E INSTALL. INGDRESS '.n,' TA N
LU C 'l �77
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O-VF—IN/CLOSIMG-
CFC/SEWER
This application hereby request and authoriie&the 'Utility to render water aiidvor sewag6 disposal
GUAR.REV.
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services to the premi*es described above in accordance with the-Utilities present or.future rates,
LATERAL rules and regulations;which by reference are made a part of this contract Applicant agree's to pay
the Utrhty proftiptly*for such'services in accordance with the.established rules and regulations.
CUST(?
TOTAL 'DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SECt
'SIGNATURE.
AD ID' y. � ( , � � � C�
ME OF-SPO
SPOUSE SOCIAL SEC
OFFICE USE ONLY
DATE RECEIVED CASH CHK#' RECEIVED
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