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RESIDENT SIGNATU <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 party in the area described as: <br />ye C� ��I � �. r1 from E J� ) L i � �� to `�s <br />Street Name C&98 Street Cross Street <br />Date of Event <br />1. <br />Signature <br />Name <br />Address <br />Phone No. <br />2 U 3 -13/5 - 710 5- <br />Date <br />f <br />2. <br />Signature <br />Name <br />; Z� <br />Address <br />GAS �! 1� l u X s 1,� <br />Phone No. <br />9 s y <br />Date <br />` 5 ) % <br />Signature <br />._ <br />Name <br />C <br />Address <br />�r�vfl Qn./1 b r . <br />Phone No. <br />5 1y 3�q -` & f <br />Date <br />r <br />4. Signatures <br />Name <br />Address <br />2,111 12� "4 W_ C t" <br />Phone No. <br />5"7 `' '913�2-- <br />Date <br />�ll�ll�ll <br />5. <br />Signature <br />y� <br />& ,L LW P) GUMo4.LT <br />( <br />Name <br />; <br />CwCWN LQ w <br />Address <br />14 S \�(Kg-_61t,, V' <br />Phone No. <br />_Z <br />Date <br />5 i <br />6. <br />SignaL����� <br />Name k214 1LC IN <br />7. <br />S. <br />9. <br />10. <br />Address <br />z-- <br />Phone No. <br />% <br />Date <br />2 dA 7 <br />Signature <br />Name <br />]7 -0- 01 <br />Address <br />) 9 G.P% <br />Phone No. <br />— / `F 7 <br />Date <br />�" a �� eZ <br />Signature <br />c' <br />A' <br />� <br />Name <br />Gl` <br />Address <br />Phone No. <br />Date <br />Signature <br />Name <br />Address <br />Phone No. <br />Date \ <br />7 <br />Signature `(; /k � <br />Name f x ivy 16 `tY\-+w <br />Address <br />Phone No. <br />Date <br />I��IIIIIIIPiq <br />Dig, <br />Updated 6/22/12 5 <br />