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RESIDENT SIGNATURES Page of <br />We have been informed, agree to, and request that the Board of Public Works of the City of <br />South Bend authorize a block party in the area described as:L' JAI // <br />S from Cj i r to L P_ 4e� n C6 4w <br />Street NAme Cross Street Cross Street <br />Date of Event <br />1. <br />Signature A <br />Name <br />Address BIZ LiS <br />Phone No. [eta}1 <br />2. <br />3. <br />H <br />Date' <br />Signature�n <br />Name <br />/f, ��,% �f �l, s✓s. <br />Address <br />412 LZ°L xr <br />Phone No. <br />1j 2 y 36�Z.� C <br />Date . <br />- %A - I <br />Signature <br />. . L/A Scc {.+ <br />Name <br />ceE# <br />Address <br />Phone No. <br />5w 3/v-1,56D <br />Date <br />Signature <br />i <br />Name <br />��(},LkjX,x Ocii L <br />Address <br />Paf-k AcE- <br />Phone No. <br />51- 327 H 6q <br />Date <br />5. <br />Signature <br />Name <br />Address �r G <br />Phone No. <br />Date <br />M <br />Signature /I <br />Name CJ A112 : LZ3t JY1(4� i1 <br />Address 733 t4 S Ca&- <br />Phone No. <br />Date <br />Signature <br />Name <br />3-1d, L1v�" <br />Address <br />Phone No. C <br />Date <br />8. <br />Signature <br />Name <br />Address <br />Phone No. <br />a <br />10. <br />Date r -" 1 I <br />Signature �}' ,�wdl� <br />Name ����``�'s <br />Address <br />Phone No. <br />�I <br />Date <br />Signature (�/; <br />Name ? 1 I .- ,f �;� t x , <br />Address <br />Phone No. ,S lq , /a t,©� r �/ <br />Date <br />Updated 4/2013 <br />