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Special Event - Ellsworth Block Party-July 2
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Special Event - Ellsworth Block Party-July 2
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6/22/2021 3:25:51 PM
Creation date
6/22/2021 3:25:40 PM
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Board of Public Works
Document Type
Recommendations
Document Date
6/22/2021
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Neighbor Signature Sheet - Neighborhood Special Event <br />We have been informed, agree to, and request that the Special Events Committee of the City of South Bend authorize a <br />party in the area described as: <br />�bbllock <br />from S6/ to <br />Street Name Cross Street Cross Str t <br />Date of Event: <br />1. <br />Signature <br />6. <br />Signature <br />Name <br />LC,vr� Cid ✓ham <br />Name <br />bcLi:C�-- <br />C""-' 1 ;� <br />Address <br />t 2( 1f t 1 P( <br />Address <br />(� t1,SU.�.o:7h <br />Phone No. <br />"4Y - 3 r _ t7 `7' <br />Phone No. <br />Sly 2S.2 <br />Date <br />` (?-0 Z I <br />! (; <br />Date <br />2• <br />Signature <br />7• <br />Signature <br />Name <br />9 C <br />Name <br />f <br />4-1 <br />Address <br />- <br />Address <br />iO3 S EEls�vcr PC. <br />Phone No.Phone <br />.. .. <br />No. <br />(r- J -79--7 t -7 <br />J F l,.•' i <br />Date <br />Date <br />3. <br />Signature <br />J <br />8• <br />Signature <br />n C9 -C_ <br />Name <br />/ <br />Name <br />Address <br />l3 r /� <br />Address <br />V, <br />Phone No. <br />3�/ <br />Phone No. <br />Date/Date <br />4. <br />Signature <br />`7l J <br />� <br />9• <br />Signature <br />1 <br />. <br />Name <br />�.j ' `1 <br />Name <br />Q S < CIn <br />Address <br />i e-li� ; / I <br />Address <br />h4�C�4+� <br />Phone No. <br />i 7'� ,- �:? � � <br />Phone No. <br />Date <br />�C�!� <br />Date <br />�c <br />5. <br />Signature <br />A <br />nature <br />Signature <br />g <br />Name <br />/ , <br />C <br />Name <br />L <br />Address <br />J <br />Address <br />Phone No. <br />G <br />Phone No. <br />Date <br />�r r,� <br />Date <br />A4y <br />
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