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SOUTH BEND <br />r ECONO IIC DEVELOPMENT <br />- p�.�r-:!7- CO- MISSION <br />x % 227 West Jefferson Boulevard, South Bend, Indiana <br />ATTENDEE SIGN -IN SHEET <br />Date: September 18, 2025 <br />As a matter of complying with Title VI of the federal Civil Rights Act and as a <br />condition of receiving federal financial assistance, as administered through the Indiana <br />Department of Transportation, including federal financial assistance in connection with <br />projects that may come before the Economic Development Commission, the City of <br />South Bend is required to collect certain identifying information regarding members of <br />the public attending Economic Development Commission meetings. <br />To assist the City in this effort, please do the following: (1) Print your full name and <br />address clearly and legibly on the lines below. (2) Complete the 3 columns to the <br />right of your name and address using the following letter codes: <br />• W (White/Caucasian), AA (African American), H (Hispanic), NB (Nonbinary) or <br />O (Other). <br />• M (male) or F (female) <br />• D (disabled), if applicable <br />Name (Please Print) Business/Address W,AA,H, <br />/� NBor <br />t)CA L 1 (� c�� a �� <br />/ <br />eo Cn8evl�410 juew Daqw <br />M or <br />D <br />F <br />F <br />A <br />- �7-lei <br />F <br />O tnn <br />I <br />J <br />� <br />