Honorary Street Sign - John Floyd Dr.

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PLACEMENT OF HONORARY SIGN WITHIN THE PUBLIC RIGHT-OF- �� WAY OR ON PUBLIC PROPERTY APPLICATION For Office Use Only: City of South Bend — Board of Public Works ❑Application Complete Flo Au F.227 W. Jefferson Boulevard, Ste. 1316, ❑Fee Received South Bend IN 46601 ❑ Petition Complete APPLICATION INFORMATION Applicant's Name: /V 1C� Applicant's Address:�.L_ A 3 O % e rr N r Sn h �j n Email Address: 1 r p,l r,,I'Af iT8o jn« t 1. C-0 hn Telephone/Cell: 3 zi �o 44 — �0 50 Honorary Sign Request: i/Y� Honorary Sign Request Name (sign should read): l �I In F(01�.1 (St., Blvd., LA, Etc)Is this individual deceased? (St., \-L Yes _ No (if no, individual is not eligible for honorary sign.) If the Board approves the petition, the petitioner must pay two hundred and 00/100 ($200) per sign to be manufactured and installed by City employees. The City will neither approve or install more than four (4) Honorary Street Signs per Honoree. Proposed Location(s): II Location # 1: Intersection of & - _ �r�) e 0 ti Location #2: Intersection of & Location #3: Intersection of & Location #4: Intersection of & (Example: Intersection of North Et South Street) Did the individual live in South Bend? Yes — No (if no, individual is not eligible forhonorarysign.) Significance of Location to Honoree's Life: %Be_CGl use_ k e. re IJY C ckr e U a 6O a l k P r\ S e*j,nci a edL�c_aJ_joa__he cusn warxeJ for s o f school {{��r�o �� Wrn c`� ��5e �� C �r2r1S 1��es REQUI ED SU6 I ALS° �"�]�,� lr,pff�f I. ��r-y�� nov,�c S Please include the following items alvng�itTfyour request. TIM [j hn F)M _ ✓ A statement of not less than 500 words describing the significance of the person being honored. The statement should include detailed information about the proposed Honoree summarizing the Honoree's accomplishments, connection to South Bend, Indiana, and reasons as to why the person should be publicly recognized. ✓ A petition or support for the proposed Honorary Sign. The petition should be signed by not less than 200 residents of the City of South Bend and must include the name, address, age, signature, and date of signing. [Note: All information on the petition must be legible in order to be considered.] Upon submission of the Application, please allow eight (8) 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. CITY OF SOUTH BEND, JNDIANA BOARD OF PUBLIC WORKS laaa SIGNATURE OF APPLICANT Elimbeth A. Maradik, President My ay,p4ication consists of the following items: (please check)a Tr Completed Application Form Gary A.Gilot,Member ❑ $150 Application Fee (Make checks payable to: City of South Bend) Fee goes t, ' ` IL?�Typed statement describing the significance of the person being honored as de Murtay L. Miller, Member Petition of support Signature Printed Name Date ✓E Joseph R. Molnar, Vice President bAl Jmdda= V. Gahm, Member Attest: Theresa M. Heffner, Clerk Dare: Mach 28, 2023