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—De-C)T%. \ '6 <br />RESWYM SIGNAILRES 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: <br />L 1v from "'Y to-L—S�ke—y� <br />Street Name Cross Street Cross Street <br />Date of Event <br />1. <br />6. <br />Signature <br />Signature <br />Name <br />'TU\V'\ <br />He <br />Name <br />Address <br />5 o <br />EA-'AS016, <br />Address <br />Phone No. <br />23-S-3 <br />5-).y <br />Phone No. <br />Date <br />2. <br />Signature <br />Name <br />Address <br />3. <br />H <br />5. <br />Date <br />7. <br />Signature <br />Name <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />Signature: <br />Signature <br />Name <br />4-'-L- <br />Name <br />Address <br />'7 <br />Address <br />Phone No. <br />Z -3 <br />Phone No. <br />Date <br />Date <br />Signature <br />9.Signature <br />Name <br />M �e LI I AG-J,- <br />Name <br />Address <br />Address <br />Phone No. <br />a ZELL j h5LS <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. L), Zj� <br />Date O") /I (,' <br />Date <br />10. <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Updated 4/2013 5 <br />