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:_ 1._a. . <br />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 parry in the area described as: <br />fromAyrto r yov, Am. <br />Street Name Coss Street Cross Street <br />Date of Event <br />6. <br />Signature <br />Name KI(✓ <br />Address 0 J,�; &tA i f an'VCAI <br />Phone No. �2—50� — Z <br />2. <br />3. <br />11 <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />-a6/ <br />DateI ({� <br />5. f� <br />Signature �G�C%✓�,�� <br />Name (rJ� r I���Uy((,i( ( I (e <br />Address -l�U ccu'i ry&'a)plhe< <br />Phone No. ��� ��� -� <br />Date <br />Updated 4/2013 <br />7. <br />Signature (� alk<�44 <br />Name bn, Aley'CAV <br />Address 7a I ma m <br />Phone No. J -N 3& %- <br />Date % y <br />Signature <br />Name��C�� <br />Addressi,dlit�/ <br />Phone No. a 7 7 <br />Date <br />8. ��Signature ��' <br />Name FU sjt� 1 k4 ti-v i k <br />Address "11c1 Cal-, inn-4 I I p, Ay` <br />Phone No. <br />Date l I <br />9. <br />Signature n <br />Name <br />Address I SN <br />G( j?� <br />Phone No. Cj iy\� -7' C 2L <br />Date <br />Signature <br />Name j SyWt <br />Address <br />Phone No. <br />Datef.'-�1FG—mil <br />5 <br />