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SIDENT SIGNATURES 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 />r <br />a from to ... <br />1�1et Name ross Street Cross Street <br />fE <br />Date o vent <br />1. 6. <br />2. <br />3. <br />H <br />5. <br />Signature n Signature <br />Name \ . y- <br />Name <br />Address <br />% y ` <br />Address <br />Phone No. <br />�� 6(5a <br />Phone No. <br />Date <br />Date <br />Signature <br />r <br />Signature <br />Name <br />Name <br />Address <br />41 <br />Address <br />Phone No. <br />-0 <br />Phone No. <br />Date <br />/ <br />Date <br />8. <br />Signature �tJ�.�u�' �1 J��,�-Signature <br />r' Name `�CL1..; t ( — R (.I;o&v, <br />Address L3 ' 'er,, a -VI <br />Phone No. 5 Z L-k ' ':) :�2 53 o L4-7i� <br />Date ? -- -;s - t-) <br />Signature <br />Naive <br />Address -2+ (13 <br />� <br />Phone No. <br />Name <br />Address <br />Phone No <br />Date <br />9. <br />Signature <br />Date -- — <br />� 10. <br />Signatur <br />Nametn& ix s <br />Address ..7 ,A o <br />Phone No. j -'� <br />Date '-7 1 <br />Name <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />�.II�1��:�1 ■ `�r � <br />Updated 4/2013 5 <br />