dmid hud f i, fh dii m u Plii Svi ' ifmi vidd h whih whih f k, gm xui h i kwldg vidd m xud f gm mi diu, uhi hv Di Bd h T ig li mlig um ud Plii Svi ulh

Transcription

1 S NTO SPECIL UTILITY D ISTRICT S ERVICE PPLICTION ND GREEMENT P O Bx 248 S, Tx P l Pi: D TE PPLICNT'S NME CO- PPLICNT'S NME C URRENT BILLING DDRESS: FUTURE BILLING DDRESS: PHONE NUMBER - Hm () - Wk () - DRIVER'S LICENSE NUMBER OF PPLICNT DDRESS T WHICH PPLICNT REQUESTS SERVICE: CREGE HOUSEHOLD SIZE NUMBER IN FMILY LIVESTOCK & NUMBER S PECIL SERVICE NEEDS OF PPLICNT NOTE: FORM MUST BE COMPLETED BY PPLICNT ONLY MP OF S ERVICE LOCTION REQUEST MUST BE TTCHED ll dliv / w li uh, iv, / v fm i d Svi Plii, mdd fm im im Bd Di U mli id Plii, i ludig m di, m ligil iv vi

2 dmid hud f i, fh dii m u Plii Svi ' ifmi vidd h whih whih f k, gm xui h i kwldg vidd m xud f gm mi diu, uhi hv Di Bd h T ig li mlig um ud Plii Svi ulhd ' quid hg f, uili h udd, mid diud, im ll - gm igd u, h i ul lh illd fuhd m md ll um u l f i w / m i() Exi ui (1) dwllig (1) l vid um ll, h,, fm uili f hiid,, ui, dwllig,, i m l igh hv h i ' m ' u ld quim m i hv, i d u f im l ll m diu u i, ui i fu ' fm quim i mv igh hv hll fm li x, w i ill, um iludig u, li i quim filii ' gul, u dvi, vi kflw vlv, li vi l - u, hv l ifid m quim il f iig u f ' - mil, ld illgl hzd, mii il i, lig guli u fdl vili il vili Cd & Sf Hlh Tx 341 Ch W Dikig Sf fdl Plii Svi f il h T fm ul dikig ig Th i im fm ul uld whih llui mii l i whih ii um h i v gm i vid uli u ii f hiid i udil fllwig wlf hlh guli: il ul dikig uli w i di N mi mii u mii u Pil d i ig m uli fm ld guli d kflw vi ml i N - ul dikig uli w i iv dikig uli h il mid m illi i limid ul u dud ig f - ml kflw vi z

3 g vi ifid ig ii ul f x mu m kflw vi dvi iduil lig, dig, llw whih i N mid ul dikig uli ud i N d f ud m % ld 80 h m i whih fiig i 1988, 1, Jul f lumig i illi umi hum f i whih vid m % ld 02 h m i whih flux ld N f ud i 1988, 1, Jul f lumig i illi umi hum f hih vid w lg gm mii u d m d/ llw m li il f id hi - il i, ii mil ld illgl hzd, mii i i g digd i dud iiig ' duig dud ii f idill i mgi x hu, ui ml i wiig if h T - i i udil iiil duig idifid hv whih udil immdil ii uqu ill, l x, i, m i i kflw vi mii, Ci quid dvi quid vidd d mi ig ll u gm m ml Filu ill, l mi kflw i mii, id x i dvi vi illd gm fm m iuffii ul l v I d, hg v i um, ll ' i ifid Pgm Riig Emg iii m g h gm, xui B Plii vi S id gm m ml fm hml hld h, xui B k li du iui ud dmg f lim ll u mig, lik uili, m/u l ' d v m, filu ml m() dd m g igh l vidig u f did d f i, lll, ugd, l, mii, u, llw u wll h v filii m vidig i u i D - fuu xig f id w um h g h, xui B - mli mii diu, juif id gm m

4 d vili im uh uil ui fi g fu f mi m uu diu i ul gm Plii Svi ' dii ih W vd D d vd

5 Y OU CN NOW REQUEST THT PERSONL INFORMTION C ONTINED IN OUR UTILITY RECORDS N OT BE RELESED TO UNUTHORIZED PERSONS Tx Lglu h d ill, llwig ulil- wd uilii giv i um i mkig um dd, lh um, u d, il ui um fidil {TX Uili Cd Cfidil, S uh B ()} I S THERE CHRGE FOR THIS SERVICE? Y - im hg $1000 v g i mlmi whih mu id im qu H OW CN YOU REQUEST THIS? Siml ml fm m g u i u hk m d f $1000 : S Sil Uili, PO Bx 248, S, TX Y u if u d w h WE MUST STILL PROVIDE THIS INFORMTION UNDER LW TO C ERTIN PERSONS W mu ill vid ifmi (1) fiil ml liil udivi, fdl gvm ig i fiil i; (2) ml uili ig i i ml dui; (3) um ig g; (4) u vd vidig vi uili, liil udivi, fdl gvm, g fdl gvm; (5) f whm um h ull wivd fidili f l ifmi; (6) i h vid, w, w, g, gg, lii, dig vi f mi D h Ru Th Si Y, I w u mk m l ifmi (dd, lh um, il ui um) fidil I hv ld m m $ 1000 f N m u Hld u Num dd Cd/Tlh Num C i, S, Zi Cd Sigu