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RESIi)ENT SIGNATURES Page of <br />We have been informed, 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 as: <br />Street Name <br />Date of Event <br />1. <br />2. <br />3. <br />4. <br />from <br />Cross Street <br />Signature <br />" <br />Name <br />Address <br />r l " a <br />Phone No. <br />Date <br />Signature <br />/ <br />CO C�A5 <br />Name <br />; Gi <br />Address <br />�2 �G' f. <br />Phone No. <br />3 <br />7. <br />45 <br />Date <br />l 0 <br />8. <br />Signature <br />Name <br />p� <br />Address <br />�"l �a �Le 6V <br />Phone No. <br />Date <br />_ r <br />Signature <br />9. <br />Name <br />Address <br />to <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Cross Street <br />r>,M <br />1/ 5a-= 5t. <br />)2.E <br />Address <br />Phone No. C <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />5. <br />10. <br />Signature <br />Signature <br />Name <br />,� ����'�'r�2 Name <br />Address <br />t O L r �� f g Ci+' <br />Address <br />Phone No. <br />317 ,1'y 7� 0 <br />Phone No. <br />Date <br />1 h Z '5 ! f V <br />Date <br />q -2- <br />�0rIYJN4--�fV'1 <br />'6"a q <br />4,7(-r1 a <br />Updated 9/2017 5 <br />