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City of Fridley
Water Deparhnent
Address c���(� �,,_���
Name__'�'YLt1��l' �
Date �-�,��
Old Meter Number �c� I �� -
Old Meter Readin a ��
Replacement No. lJ�`7���
Replacement Reading �
Replacement Make C�Y4�9�.
ERT# � ` L�S�� V�
Replacement ERT#
Remarks: �Ok'E]�V�� �fi� �� �`�
Signed (��'7�•,,Q .��'