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RESIDENT SIGNATURES Page 4 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 />�c from to <br />Street Name 11 s Street Cross Street <br />Date of Event c (�;O1�- <br />X. 6. QQ►u '&n Al. <br />Signature Q Signature <br />Name Name-- <br />2. <br />3. <br />Address 5 � OA Oh&(! Ri-�6 r _ DR <br />Phone No. <br />Date YLLI7 <br />Signature 7? <br />Name <br />Address � <br />Phone No. S74 -3— 3 S <br />Date <br />Signature <br />Name i <br />Address (-)�-Vulp <br />Phone No. � 4 q <br />Date <br />4. Signature <br />Name <br />Address <br />5. <br />W\ <br />3`i0CI 00,1'*-SA ` )r. <br />Phone No..3 t i T) - 3's (a <br />Date <br />Signature <br />Namc. <br />Address <br />Phone No. ` 1, u <br />Date 1 <br />Address <br />39 ) 7 atkcreS r -- <br />Phone No. <br />V4"W` 1 O% <br />Date <br />7. <br />Signature <br />l A.- A2, <br />Name. <br />�l ��-- <br />Address <br />L J �� G �/��• <br />Phone No. <br />Date <br />//�`j <br />�i <br />8. Signature <br />��!-�-i/h <br />Name <br />SGi P iC ! D e s 7 / fl <br />Address <br />Q� <br />a <br />Phone No. 5 3a - � W % <br />Date l / <br />Signature <br />Name �V'ACAC <br />Address <br />Phone No. <br />Date <br />10. <br />Signature <br />Name <br />Address <br />Phone No. <br />Date <br />Updated 6/22/12 5 <br />