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RESIDENT SIGNATURES page of <br />We have been informed, agree to, and request that the Board of Public Works of the City of <br />South Bend authorize a block party in the area described as: y <br />+ from }-�111i1. �� to <br />Street Name Cross Street Cross Street <br />Date of Event <br />1 Signature{,��' 6 Signature ;"'/!x <br />'—i <br />Name n.3'cy Name <br />Address j � ,!�/ �fj�/(� �, Address ' % Iz '< 11 ` ' <br />Phone No. 5-7 GZ,�)O Phone No. f, <br />Date Date <br />2. <br />Signature Signature <br />Name Name <br />Address ```� �3lZb�(��L� Address <br />Phone No. Phone No. <br />3. <br />H <br />5. <br />Date <br />Signature <br />Name <br />Address <br />I <br />Phone No. <br />Date <br />Slab/av/� <br />9. <br />Signature <br />Name <br />jJ.h <br />1 <br />Address <br />Phone No. <br />674 b 3 " L4 qtj <br />Date <br />i <br />Signature <br />t 0. <br />Name <br />IrlllruG 1 >ZGi�Gh <br />Address <br />Phone No. <br />�t�j <br />q Oq <br />Date <br />ti <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. lwty ''-&2 /YD <br />Date <br />Signature <br />4 SC kO C <br />Name <br />C� S:o LA <br />Address <br />/�� jj <br />132G laroe�l.;a j <br />Phone No. <br />57q qo q q 13Q, <br />Date <br />6- L q ' / 6 <br />Updated 4/2013 <br />