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RESIDENT SIGNATURES <br />Page <br />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 />from d � I i <br />to <br />Street Name <br />Criss Street <br />Cross Street <br />Date of Event �—'t <br />IT_ ( �� <br />1. <br />Signature <br />6. <br />Signature <br />Name <br />e <br />C�r..,a ('. �ah� <br />Name <br />Address <br />.Ra a 5 jVa6 <br />Address <br />Phone No. <br />lalai — Am <br />Phone No. <br />Date <br />Date <br />2. <br />7. <br />Signatur <br />_.._ <br />F�Z' <br />Signature <br />Name -1 <br />Name <br />Address <br />Qa—:� , j r, <br />Address <br />Phone No. <br />Phone No. <br />Date <br />�� <br />Date <br />3. <br />$. <br />Signature <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />4. <br />9. <br />Signature <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />5 <br />10. <br />Signature <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Phone No. <br />Phone No. <br />Date <br />Date <br />Updated 6/22/12 5 <br />