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RESIDENT SIGNATURES <br />Page of <br />Wo.have-been informed, agree to, and request that the Board of Puhkic Works of the City of <br />South Bend authorize a block party in the area described as: <br />rMM �' from -C)-1 U AW✓t'I to <br />Street Name I Cross Street Cross Street <br />Date of Event <br />/ �l <br />1. Signature <br />Name <br />C� <br />Address <br />Phone No. <br />2. <br />Date <br />g �5' le <br />Signature <br />Name <br />Address <br />Phone No. <br />317- <br />Date <br />3. Signature <br />Name <br />Address <br />4. <br />Phone No. -+3y , q80_ <br />Date <br />Signature/A <br />Name CC•�/ �� <br />Address <br />Phone No. 5771 "ZZO -Z 3--7- R- <br />Date g�i�0�6 <br />Signature ,( <br />Name <br />Address <br />ItaOi E �`o) Av� <br />Phone No, <br />Date <br />6. Signature <br />Name g V>fi W IV <br />Address InS- e. Cri�lx <br />Phone No. <br />Date <br />7. Signature! -� <br />a <br />10. <br />Name <br />Address <br />Phone No. <br />� �?J 2 70 <br />Date-'-r� <br />Signature <br />Name <br />t —# - _ I, <br />Q�,� * 11„�h <br />&)r <br />Address <br />Iy���(An'�(, <br />C) <br />Phone No. <br />k_5 n, <br />Date <br />_ 1 �j—�� <br />l <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />.j' <br />Updated 4/2013 <br />