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RESIDENT SIGNATURES <br />page of <br />b <br />We have been infoirned, 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 <br />as: <br />1- <br />�- \1 <br />from�� f� i � f�i � <br />� 'vim to <br />Street Name <br />Cross Street <br />Cross Street <br />Date of Event <br />1. <br />Signature <br />b. 4 <br />Signature <br />Name <br />A.ti (ub� <br />Name <br />Address <br />j G { 7 <br />Address <br />/ Ili as <br />Phone No. <br />�-- ~� ^~ <br />Phone No. <br />Date <br />g1jA ( <br />Date <br />Signature <br />7. <br />(.() <br />Signature <br />Narne <br />SL Y�cf <br />Name <br />Address <br />I us-&L....- <br />Address <br />✓cam <br />Phone No. <br />Phone No. <br />I <br />Date <br />Date <br />Signature <br />Signature <br />Name� <br />Name <br />Address <br />' ! <br />Address <br />SS f <br />Phone No. <br />� �-'l 0 7 <br />Phone No. <br />Date <br />;, <br />Date <br />4. ' <br />9. <br />Signature <br />Signature <br />�b- <br />Narne <br />Name <br />Address <br />Q <br />l"r r ,�1� �� <br />Address <br />�s <br />Phone No. <br />Phone No. <br />Date <br />JI <br />Date <br />5. <br />10. <br />�� <br />Signature <br />Signature <br />Name�'r'1'�:� <br />t��r <br />Name <br />Address <br />rr <br />Address <br />Phone No. <br />S 761 .-A j 0 77 q 2 <br />Phone No. <br />Date <br />0 q ` L '" 201 I <br />Date <br />Updated 4/20I3 5 <br />