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RESIDENT SIGNATURES Page of <br />We have been inforined, agree to, and request that the Board of Public Works of the City of <br />South Bend authorize a block party <br />%in the area described as: <br />from (1 �! ��"� _ to (/t <br />Street Name Cross Street Coss Street <br />Date of Event <br />1. <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />2. <br />Signature <br />Name <br />Address <br />3. <br />40", <br />Phone No. y13 ` (P <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />i IE <br />► <br />r �! <br />i <br />31 <br />.7. <br />Date <br />4. <br />Signature <br />/1/1, a !1 y� 9. <br />Name <br />M/� <br />Address <br />�� Z� /,t <br />Phone No. <br />7 <br />Date C <br />5. <br />Signature <br />10. <br />) <br />Name <br />OPri iVACe—, <br />Address <br />�] a OJ , 6CO dx_-c(A <br />Phone No. <br />�7q 90,3 -L l <br />Date <br />�,}, o� <br />Signature a U try ( Q( <br />Name 6_61- CO ke- <br />AddressS- <br />Phone No.j�L( <br />Date <br />Signature <br />Name rQ <br />Address } <br />Phone No. <br />Date ((J b y l <br />Signature <br />Name dC� <br />Address <br />Phone No. <br />Date <br />Signaturecl�a <br />G <br />Name <br />Address <br />PhoneNo. <br />Date <br />Signature 1. <br />Name <br />Address <br />Phone No. <br />Date 1— ::L "- , <br />Updated 4/2013 5 <br />