Special Event - Eddie C. Tyler IV Memorial - June 3

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• 0 • cTe g. City of South Bend Special Event Application Neighborhood Event 4_ A y $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN Review the Instructions on the Special Events page before completing the application. Neighborhood Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. MAY 0 2 2 tion A- Applicant Information Date of Application: Organization Name: a d /E (�_ T lA/f LV /HE.Nn!e // Applicant (Contact) Name: /%,n Q/// tfA- yt"EF 1 Ju L/ /�/11�A/11 /L%O T�Ei1'i Applicant (Contact) Phone: 51V-y.?5-M S Contact Email: Address:V5 _rdkyw,U_C4- City/State/ZIP: Se Contact Name: Contact Phone: Contact Email: Address: City/State/ZIP: Section B - Event Information Event Name: En6/F�7 T—V&—rWA//4/ExpectedAttendance: O0 4- 4E4- b/ICS Requested Street Closure: Jd AWSMI TO From (Cross Street): 1qZrl7,f To (Cross Street): /// C L. St. Provide a brief description of the event: 41,4,Ub-Q,v NIJO 605S fAs I-Ar.6rTo "G'uN 099Lolec 0u 0.1,SAR- ,511A104y Nd1ZA11; j %N �06u v TOlu,u .50u tH Date of Event Setup[mm/dd/yy]: JU.U6 ime: J-7 /� • Begin Date of Event [mm/dd/yy]: %U[UE 3. 20a3 Time: _ /; 00 !%N. End Date of Event [mm/dd/yy]: 7U UE 3, a0o73 Time: /y. GU 0`7 L/. Event Cleanup Completion [mm/dd/yy]: %U[UE F, a7da7 3 Time: 57.E d0 /;/L! - Have all residents on the affected block have been notified and invited? ❑ Yes ❑ No Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. Number of households fronting the proposed street closure: 7 ry Number of households represented by signatures on attached sheet / Will this event have music (live or other)? % Yes 0 No