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RESIDENT SIGNATURES <br />page d, O <br />of <br />We have been informed, agree to, and request that the Board of Public Works of the City of <br />Sou1/thBend authorize a block party in the area described as: <br />Y A-,S H <br />from <br />Street Name Cross Street <br />Cross Street <br />Date of Event <br />1. <br />Signature <br />6. <br />Signature <br />Name <br />Name <br />Address <br />� P 44� <br />Address <br />16 <br />Phone No. <br />Phone No, <br />Date <br />m <br />Date <br />2 <br />Signature <br />_.�-<Jr 7. <br />;°,,/ { ?`% <br />Signature <br />Name' <br />1`�'� ; <br />Name <br />Address <br />As <br />Address <br />Phone No, <br />Phone No. <br />Date` <br />y um�r.� <br />Date <br />3. <br />Signature <br />Signature <br />rr <br />— <br />Name <br />; A� t� itl e K <br />Name <br />Address <br />'/ Ma 5h <br />Address <br />Phone No. <br />Date <br />2 7/ <br />Phone No. <br />Date <br />4. Signature <br />g <br />If c�✓,mac„If \ 9. <br />� � '' <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />5. <br />Signature <br />10. <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />Updated 4/20I3 5 <br />