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I understand the above rules and regulations and that this application may be denied based on <br />any false or incomplete in xmation. <br />Sponsor Signature C7� <br />Printed Name Donna L. Go[ob <br />Title Executive Director <br />-� BOARD OF PU LIC WORKS APPROVAL <br />President Member Member <br />Member Me ber Date <br />RE, TURN FORM TO. 4 <br />Board of Public Works <br />13I6 County -City Building <br />227 West Jefferson Boulevard <br />South bend, IN 46601 <br />Phone: (574) 235-9251 r Fax: (574) 235-9171 <br />