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PETMON OF SUPPORT FOR PLACEMENT OF HONORARY SIGN WITHIN THE <br />PUBLIC RIGHT-OF-WAY OR ON PUBLIC PROPERTY <br />City of South Bend - Board of Public Works <br />« 227 W. Jefferson Boulevard, Ste. 1316 <br />x � t s South Bend, IN 46601 <br />ts <br />Honorary Sign Request Name (Sign should read): <br />Proposed Location(s): ®4 ��� L ` AJ f%-i-J <br />AS A RESIDENT OFTHE CITY OF SOUTH BEND, INDIANA, I SUPPORTTHE PROPOSED HONORARY <br />SIGN OR FEATURE. <br />�AdJ--I J- 4LQU1-'{ <br />Prin4�\I-f <br />ame 8i Address <br />Printed Name & Address _ _ ignature Date Age <br />.� o �y S� / 1 T' S V %,1 n ��"� `i 1 I 0 .1 3 (o Ll <br />Printed Name & Address Signature Date Age <br />(,mil tt, / M iv V r /f5 -77,76'7 r ��"! r d /z'- G <br />Printed Name & Ad mcs ate Age <br />J[ <br />r <br />_a, N, `7" - -rz Y� <br />Printed qame & Addre 3s Signature Date Age <br />nddi <br />7Pnnted. me • as 5i na[ur ❑a Age <br />Printed ame & Add •ess gnature Date Age <br />Printed Name & Adc ess Si nature Date Age <br />Page ('Z of <br />