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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 />JSoouthh ,Bend authorize a block party in <br />the areadescribedas: <br />� (U'fit-['6'1 from �/�-w to <br />Street Name Cross Street Cross`Street <br />Date of Event <br />1. <br />Signature <br />Name <br />6. <br />Signature <br />Address <br />Phone No. <br />J *! (,- <br />Date <br />Signature <br />Name <br />t� loatr.�W4/�— <br />Address <br />71Y IlayriSon T* <br />Phone No. <br />47),3/0 - 753Y/O - 7,53Y <br />Date <br />/3 <br />3. <br />Signature <br />8. <br />Name <br />Address <br />Z (Q <br />Phone No.UKIa) S ( 7 8 <br />Name Sr t1E1k)< < <br />Address 'iO I <br />Phone No. <br />Date <br />Signature ` `1 <br />Name UDG�VG 0KiL'JCx <br />Address 91'i�eJo— 'O e <br />Phone No. <br />Date <br />Signature <br />Name <br />Address ej .0 G"f <br />Phone No. <br />Date <br />Date <br />Signature <br />4 ��',(j ('j.'� <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />5. <br />10. <br />Signature <br />-- L G-- --� <br />Signature <br />Name <br />�(�,, ® G1jr Iv �e �� <br />Name <br />Address <br />8 0 V - S 7T , <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />Updated 4/2013 5 <br />