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We have been informed, agree to, and request that the Special Events Committee of the City of South Bend authorize a <br />• block party in the area described as: <br />C <br />I;treet Name <br />ti <br />/LSor <br />� <br />Cross Street <br />G✓C�.�hin <br />Date of Event: <br />1. <br />Signature <br />6. <br />Signatures <br />Name <br />ZO- , <br />Name <br />r•` <br />CAre,� Ye�,k. <br />Address <br />.�S` <br />Address <br />// S /S <br />Phone No. <br />6 1 &- S 3 } <br />Phone No. <br />Date <br />®J�j�v <br />Date51 <br />P <br />2. <br />Signature <br />7. <br />Signature <br />Name <br />((�� '' <br />(7r e+rk� Cc��'� V10� �^y <br />D% /Sw .•JJ <br />Name <br />Ma P <br />L <br />Address <br />Address <br />//! <br />Phone No. <br />514 - 301 - 379�-7 <br />Phone No. <br />1 , <br />Date <br />5/ Z <br />Date <br />3. <br />Signature <br />8. <br />Signature <br />Name <br />^ <br />.{ � i <br />-for <br />Name <br />a <br />Address <br />1 1 S, <br />Address <br />/5 <br />Phone No. <br />O 0361'a2 <br />Phone No. <br />/ _ 7ly- MO <br />Date <br />Z <br />Z <br />Date <br />�/� O <br />4. <br />Signature <br />9. <br />Signature <br />Name <br />Phn, � a <br />Name <br />SQ <br />Address <br />c>! /S`��`�� <br />Address <br />��^ <br />Phone No. <br />S -� �0 3 <br />Phone No. <br />/I 1 Sf Sl _ <br />vvsol <br />Date <br />jj /�� O� <br />Date <br />d <br />✓i/ V <br />5. <br />Signature <br />10. <br />Signature <br />Name <br />!!!!k ���,� ���' <br />f,,,,`"`---- � <br />Name <br />Address <br />f O aV <br />Address <br />3/ � /d? as / <br />