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City of South Bend Special Event Application <br />Neighborhood Event <br />$25 application fee if filed 45 days or greater (up to 180 days) in advance of event <br />$50 expedited application fee if filed 14 44 days in advance of event <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 14 days In advance of the event date or the application will not <br />be accepted, <br />h oSection A - Applicant Information <br />Date of Application: Apo a D aOZ� Organization Name: <br />Applicant (Contact) <br />Applicant (Contact) Phorte: <br />r7l: <br />Address: _ ! (t^ F� (t(r 1,i p r- <-' City/Sta0 MP- 3,,J I, d <br />Secondary Contact Name•. 100plen t"�tWVe (— <br />ContactPhone:'347 IV 6401 ContactEmaik Jo4nrtg 02)q'@iVll4rl <br />Address: 116!' t1j0U*-r S} City/State/ZIP. Sour.. 13ALnd $N 4661s <br />Section B - Event Information <br />Event Name: I0CJC- Expected Attendance:"" <br />Requested Street Closure: @IO U i <br />From (Cross <br />To (Cross Street): ul 1d✓04, S' - <br />Provide a brief description of the event <br />Date of Event Setup (mm/dd/yyk 0713qlal Time: D It 0— <br />Begin Date of Event (mm/dd/yy]: Time: 8 at h" <br />End Date of Event imm/dd/yyj: O -'a �1 / Time: <br />Event Cleanup Completion[mm/dd/M: 0q /d.1 Time: <br />Have all residents on the affected block havebeen notified and invited? Fres ❑ No <br />Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. <br />Number of households fronting the proposed street closure: 1 1 _ <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? yes ❑ No <br />