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RESIDENT CI .NAIURF.S <br />Page [ of <br />We have been informed, agree to, and request that <br />the Board of Public Works of the City of <br />South Bend authorize a block party in the area described as: <br />L <br />d�.from �Vc_Fzv-'l1G.6v1 <br />to <br />Street Name Cross Street <br />Cross Street <br />Date of Event <br />Signature <br />Signature�uq <br />Name <br />�� •� Rio �o�p <br />Namen.rrk'd\ <br />Address <br />�<t< �. �„f��!2, <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />2. <br />Q 7. <br />Signature <br />ails <br />Signature <br />Name <br />lS'P.( <br />Name <br />Address <br />CA 6011 klI <br />Address <br />Phone No. <br />2-� 7 (� Zl (J <br />Phone No. <br />Date <br />fr' l !6 <br />Date <br />3. <br />8. <br />Signature <br />Signature <br />Name <br />Lb (C 4 `r�1Q, <br />Name <br />Address <br />j ��� La�gll <br />Address <br />Phone No. <br />3,>d �i i4 <br />Phone No. <br />Date <br />K 1'-k I <br />Date <br />4. <br />9. <br />Signature <br />Signature <br />Name <br />G <br />Name <br />Address <br />Address <br />Phone No. <br />-'Y1 —6��%g <br />Phone No. <br />Date <br />/ !v 1 <br />Date <br />5. 10. <br />Signature 6ZO_ <br />Signature <br />Name <br />Name <br />Address <br />3O2 N <br />Address <br />Phone No. <br />�O/ ��r-�� �O q <br />Phone No. <br />Date( <br />YJ <br />Date <br />Updated 4/2013 5 <br />