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City of South Bend Special Event Application <br />`\ Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event <br />Please Brine Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Aoplicant Information <br />Date of Application: Organization Name:_ <br />Applicant (Contact) <br />AMC G- c �t- <br />Applicant (Contact) Phor(p � 0O -3 7urontact Email: <br />Address: I (l) l ni h0Mr —City/State/ZIP: J <br />Secondary Contact Name: �l'� on C l r e-,e— <br />Contact Phone\`) 14 ) 11. `yL p*3 Contact Email: 1 <br />Address: IIU3 kji soIV""> City/State/ZIP: S 1-? <br />• '' II // y nn Section B - Event Information <br />EventName:Nl�i3C% �.i kdaW hs)k- Expected Attendance: 5 u <br />Requested Street Closure:_ <br />—TY1U �'Vl cc <br />From (Cross Street): I "if 0 krs U � <br />To (Cross Street): aaP I ref <br />Provide a brief description of the event: <br />/00 6� <br />Date of Event Setup [mm/dd/yy]: U f I LID I XQ Time: U I4 <br />Begin Date of Event [mm/dd/yy]: D Time: 2lc�l <br />End Date of Event [mm/dd/yy]: 4-�, ), Time: <br />Event Cleanup Completion [mm/dd/yy]: U Time: l <br />Have all residents on the affected block have been notified and invited? U#es ❑ No <br />Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. <br />• Number of households f ronting the proposed street closure: 4 <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? 12 Yes 0 No <br />