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APPLICATI011 <br />illi:� � ii': 11' 1 <br />The Board of Public Works must have four (4) weeks prior notice of the event. <br />%W � V, #11 W, I n 12" 17 71- ITITI Z1 0 1 W, V N (#N10V5VA'1W' # vw tAt XI.Effi <br />MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH <br />FWAVO-WOKU16101 <br />Applicant Name: <br />Denise M. Domonkos <br />Organization: <br />Our Lady of Hungary <br />731 1 <br />South Bend: <br />IN <br />I <br />46613 <br />I <br />Address: <br />W Calvert <br />Phone: 1 574-255-1906 ddomonkos@sbcsc.kl2.in.us <br />Secondary Contact Kathy Baugher Church Secretary <br />Address: 735 W Calvert <br />City: South Bend State: IN <br />Phone: 574-287-1700 Email: o11'ip@Sbc91obaLnet <br />This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the <br />specified public riAht-of-way by Applicant for the bolding of the hereinafter described event: <br />Event Name <br />Our Lady of Hungary Parish Festival <br />Name of <br />Chapin <br />Street Closure <br />Street <br />From <br />Calvert <br />TO <br />Bruce <br />Date of Event <br />July 21 <br />120 118 <br />Time 11 Xa,m, Elpm. start 4:010 Ela,m, Xp.m. End 11:00 Da.m. Xpm. <br />Setup <br />I <br />Time Time <br />Approximate Number of 5010 <br />T1 <br />Attendees I <br />Please answer the following a22ropriately: <br />• This event will be open to residents outside the immediate neighborhood. <br />X <br />Yes <br />0 <br />No <br />• All residents on the affected block have been notified and invited. A copy <br />F-1 <br />Yes <br />X <br />No <br />of the flyer distributed is included. <br />• There is/are resident(s) affected by the event that may need ADA <br />rl <br />Yes <br />X <br />No <br />transportation assistance to their residence. <br />• This event will have music (live or other). <br />X Yes El <br />No <br />9 Payment of $50.00 fee payable to City of South Bend included <br />n Yes X <br />No <br />• For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal <br />X <br />Yes <br />11 <br />No <br />Revenue Exemption Status Document and a current copy of Form 990 or <br />Form 990-EZ are included with this application. <br />Updated 08/2017 <br />