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• <br />C -qm�Srly—mStaK 4OOT%t__ I <br />` z have bee:.::,.r..:..e.,, agree to, and request that L.e Special' events Committee ofthe City of South Send authorize a <br />block party in the area described as: <br />�,�r f em �i l cS e vl to A1 rklo <br />Date of Event: <br />1. I signature � 1 � b. SiP�� �,? I Lt-•�_ <br />a7 ( $( 9 <br />I. <br />Address <br />Ill N• Ott cwvt- el <br />Address <br />1 2 7 <br />J� <br />Phone No. <br />5- , 315 'S 2_ 1 <br />j <br />Phone No. <br />C I _ ✓ : - 3 , �_ r <br />. <br />5 "3/.�3 <br />2 <br />Signature <br />l <br />7• <br />Signature <br />Name <br />h i� <br />eae 5{qIiJl- <br />Name <br />/Jl <br />Phone No. <br />tj, 30 <br />Phone No. <br />5- 7 Z 3 2 g Z 56 <br />Date <br />5 l <br />Date <br />S. s- z o 23 <br />1 <br />Name <br />/� •�� <br />. <br />Name <br />(✓ C r <br />, Address <br />01 S EIISOI,:4 `• <br />Address <br />y S 5 zF/kdI"fi / <br />C <br />.s.Wv_.... <br />Date <br />5 23 <br />Date <br />S �-� .Z o 2 <br />4. <br />Signature <br />�`i.G.-w� <br />9' r <br />Signature <br />v,. i <br />i 64� <br />Ce <br />jd„ �� _ (I(I - f <br />Address III $ <br />S4 <br />Phone No. <br />I Date. I <br />5•. Signature <br />Name <br />! l Address j �Z <br />Phone No. 1 <br />Date n 1 <br />Sw c. ^ 1 I I I Address <br />Phone No. <br />I I. Date <br />Is7q-a33- <br />1-5&5(/-)l 3 <br />a <br />10. <br />Signature <br />Name <br />I <br />Phone No. <br />Date <br />5-7 C, 8-0�' <br />