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CITY OF SOUTH BEND, 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 Bend, Indiana 46601 , or its <br /> successor agency as a condition of receiving property tax abatement. <br /> Petitioner's Name <br /> A/ t4�z <br /> Agent's Warne Acting on Behalf of the Petitioner <br /> Contact Person <br /> p 1��/ XA <br /> Street Address <br /> City, State, ,dip Code <br /> Business Telephone Number <br /> E-mail Address <br /> JUL q <br /> A <br /> Signature of Petitioner <br /> cc: WorkOne Northern Indiana <br /> Chairperson, Community and Economic Development Committee <br /> Department of Community and Economic Development <br /> City Clerk's Office <br /> (Rev. 5/13/11) <br />