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CpU WIIRlr1Y .lIICC101 CYC(IL <br />We have been informed. agree to, and request that the Special Events Committee of the City of South Bend authorize a <br />block party in the area described as: nn I� C <br />U Rut <br />tL, Ji to N 1� Ye�+h, S� <br />Stmt Name Goss street Cross Street <br />Date of Event <br />C1I ,a"ra�d1 <br />1 <br />1. signtum <br />Name <br />Address <br />Phone No. <br />Date <br />Y-/ -.z/ <br />2. Signature <br />Name <br />r: i� Lasl�e <br />Address <br />Phone No. <br />s <br />S7`1 YVO O55 <br />Date <br />3. Signature <br />' <br />Name <br />Aearew <br />(� a L <br />Phone No. <br />Date <br />- <br />y ly 9M I <br />4. Signature <br />C„J O <br />"'me <br />Address <br />Phone No. <br />Date <br />—/ <br />5. signatum <br />Name <br />I vr*- O SM <br />Address <br />1W CI over 5Nye- <br />Phone w- <br />S 7 ti 303- 09 0 <br />Date- I-ry-ar <br />r- <br />0.�J- <br />Nam <br />Addres <br />Phone No. <br />Date <br />7. yWbure <br />Name <br />Address <br />Phare No. <br />Date <br />B SlWt re <br />Name <br />Address <br />Phone No <br />Date <br />9. Signature <br />Name <br />Address <br />Phone No. <br />Date <br />10- 1 Signature <br />Name <br />Address <br />Phone No. <br />Date <br />aw <br />Zf <br />;q —6lt74O <br />/ d001- I <br />m t� / t iG wrEr <br />pos cues" <br /><S7y) �3�t-GS0¢ <br />-/ -Z <br />2Va r'ux�"g-- ! T/�r'u r <br />.Vu, anA-; yid <br />