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e6116/2011 11:05 3378957623 PREMIER BANDAG 4 PAGE 15 <br /> CITY OF SOUTH BEND, <br /> INDIANA <br /> WORKONE NORTHERN INDIANA FORM <br /> Pursuant to Section 2-83.2 of the South Bend Municipal Code, the <br /> Petitioner referred to herein agrees to work with . WorkOne Northern <br /> Indiana, 851 South Marietta Street, South Re @nd, Indiana 46601 , or its <br /> successor agency as a condition of receiving property tax abatement. <br /> C V W Rem ( LL 6, <br /> Petitioner's Name <br /> Agent's Name Actin B _ .... R_ <br /> � 9 on Behalf of the Petitioner <br /> Contact Person <br /> X302 <br /> Street Address <br /> City, State, Zip Code <br /> 3I7 375'0 <br /> Business Telephone Number r <br /> E-mail Address <br /> Signature of Petitioner <br /> cc; Work0ne Northern Indiana <br /> Chairperson, Community and Economic Development` Committee <br /> Department of Community and Economic gevelopme,nt <br /> City Clerk's Office <br /> (Rev. 5/13/11) <br /> .?0 <br />