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2. 
4. TODAY'S DATE*
   TODAY'S DATE
7. FINAL ACCOUNT
9. ACCOUNT NAME*
12. ACCOUNT NUMBER*
14. PROPERTY ADDRESS*
    West Melbourne, FL 32904
16. TURN OFF DATE*
    TURN OFF DATE

    (Water cannot be turned off on weekends or holidays)

18. EMAIL
20. NEW MAILING ADDRESS*
22. CITY, STATE, ZIP*
24. PHONE NUMBER*
26. NOTE:
    The Post Office will not forward your bill or deposit. You must change your address with the Utility Department.
28. SIGNATURE OF ACCOUNT HOLDER(S)*

    (Type your name/s as your signature)

29. DATE*
    DATE
31. 2240 Minton Rd., West Melbourne, FL 32904
32. Phone: 321-837-7750 Fax: 321-768-2390
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

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