Street Closure - Victor & Lois Steward

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N/ APPLICATION FOR THE USE OF, AND BLOCKING OF, ACCESS TO THE PUBL . RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY The Board of Public Works must have four (4) weeks prior notice of the even 6J A NON-REFUNDABLE APPLICATION FEE OF $50.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. Applicant Name: I1IL'rd ,6 Address: )-S,'.S_ BlaNdS City: So , 6e ^'4 State: Zip Phone:. 7,Vzl©03V2-f 0/0 '7V41dc9. Z142 This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the specified public fight -of -way by Applicant for the holding of the hereinafter described event: Event Name / ri}.vU L go lve S . 7X0 e 6 7 ,,gle 64 Street Closure Name of ,gorL'C'1S Street From p11 L/ -7,ne#a1e, To Date of Event -Y'i/ly IS-4- 20 Time Setup '71.36 f5� Start e1136 Ra.m. ❑ End R,'bO ❑a.m. Np.m. a.m. p.m. El p.m. Approximate Number of Attendees 156 Please answer the following appropriately: • This event will be open to residents outside the immediate ❑ Yes No neighborhood. • All residents on the affected block have been notified and invited. A Yes ❑ No copy of the flyer distributed is included. • This event will have music (live or other). 2"" Yes ❑ No • Payment of $50.00 fee payable to City of South Bend included or: a Yes ❑ No • For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal ❑ Yes [&,-Ko Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and additionally filed with the Office of the City Clerk, 4t" Floor, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana. LCOHOL IS TO BE S O SOLD Alcoholic beverages wi e served Alcoholic beverages will be sold ❑ Certified Check or Money Order for $40 must be submitted with application. ❑ • Application cannot be proces without dep • Deposit will be returne on inspection of event ar the Board of Public Works. Updated 412013 1