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RESIDENT NATU ES 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: <br />d i -S_OA from c0a" i �i� ,,/ to A <br />Street Name I Cross Street Cross Street <br />Date of Event <br />Signature' <br />Name <br />Address �cvPlc. ' ��-�, . 7L' � CMG 1 � - <br />Phone <br />11 <br />a <br />9 <br />5. <br />Updated 4/2013 <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 />C�. �� IY ► <br />Phone No.� <br />Cl <br />Date <br />6. <br />7. <br />8. <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 />Date <br />9. <br />Signature <br />a Name <br />Address <br />Phone No. <br />Date <br />/� 10. <br />Signature �2. <br />Name <br />AddressC1w <br />Phone No. % n <br />Date — G— <br />4 <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />pj A �,O �411 <br />M %>(-kg,I S4 <br />W ZG <br />4 <br />AA R� <br />6- 1A Az % 56 Alert" <br />5 <br />