Honorary Street Sign - Adeline Wigfall Blvd.

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RECEIVED 2022 iuu7+rQ City of South Bend Div. of Engineering APPLICATION FOR PLACEMENT OF HONORARY SIGN AND OTHER HONORARY FEATURE WITHIN THE PUBLIC RIGHT-OF-WAY OR ON PUBLIC PROPERTY For Office Use Only: ❑ Application Complete Inec Received ❑ Petition Complete Comments: ❑ APPROVE ❑ DENY 1. Applicant Information -- 1 Applicant's Name: t N o Applicant's Address Email Address: Op A 2. Honorary Sign or Feature Request: Proposed Location: [, . dw et 2: Main Slreel from 1st Street to !rd Sired) "Wk- -- ■ — c-. Telephone: ! Corner ofNur h and, wxh reer Example Si iftcance of Location to Honoree's Life: �-"""'-` �"" _+C i�3. Required Submittals: �C/I L � ,- Please submit the following items a-[artth your request: ✓ A wed statement of not less than 500 words describing the si nificancc of the person being honored. The statement should include detailed information about the proposed Honoree summarizing the Honoree's accomplishments, and reasons as to why the person should be publically recognized. ✓ A petition of support for the proposed Honorary Sign or Honorary Feature. The petition should be signed by not less than filly _L50 residents of the City of South Bend and must include the name, address, signature and date of signing. The petition should be witnessed by one individual and must be notarized prior to submittal. [Note: All information on the petition must be lc�ib a in order to be considered.] Upon submission of this Application, please allow four (4) weeks for staff to review, and presentation to the City's Board of Public Works for final action. A letter will be sent to the Applicant indicating the Board's decision. In the event that the Application is denied, the Fee will be refunded to the Applicant. �0sd d T I- 4. SIGNATURE OF APPLICANT My applicati n consists of the following items: (Please check) iplcted Application Form plus one (1) copy Ltr to 0 Application Fee (Make checks payable to: City of South Bend) statement describing the significance of the person being honored VAic't-it—ion of supp (i fl �j Al Dale 'A Al Jv� !'rr amr Fonn 091001 Sub'lc-ribed and sworn before rle, anotary public on this day 29th of November, 2022 UOH BEND, -1 ADELITA MEDINA PUBLICwo�s Seal"* EiiahU A. Maratlk pwitlem IauMR Molnv, viu Raitlwn Notary I Public State of Indiana �a St Joseph County e ita Medina - Notary Public n;;lrtissinn Expires Ma.r 15, Zo24 'Milk, µ- Aabmary 14, 2023 rk