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RESIDENT SIGNATUR +�5, <br />Page I of <br />We have been informed, agree to, and request that the Board of Public <br />Works of the City of <br />South Bend authorize a block party in the area described <br />as: <br />from C to <br />/ b <br />Streggame <br />Cross Street <br />Cross Street <br />Date of Event <br />r/ <br />1. <br />Signature <br />6. <br />Signature <br />�� S <br />Name <br />Name�r� <br />kbVq Address <br />106CZS � <br />Address <br />� r <br />Phone No. <br />Phone No. <br />Date <br />Date's <br />2. <br />7. <br />Signature <br />Signature <br />Name <br />Name <br />Address <br />Address <br />Li <br />Phone No. <br />Phone No. <br />3 �9-0 3 9 <br />Date <br />Date <br />7 /3� <br />3. <br />S. <br />Signature <br />Signature <br />Name <br />/J <br />i Address <br />Oq c t <br />Name <br />Address <br />0 <br />Phone No. <br />Phone No. <br />Date <br />Date <br />713 <br />4. <br />Signature <br />9. <br />Je", S <br />Signature <br />Name <br />/ <br />(� . ! 1 <br />tt <br />Name <br />Address <br />Y. � c �ek S %� <br />Address <br />Phone No. <br />IAD X <br />Phone No. <br />Date <br />j.� <br />Date <br />5. <br />Signature <br />Name <br />10. <br />AIZ <br />Signature <br />Name <br />Address <br />1 Ck2 S', <br />Address <br />Phone No. <br />i/` 21 - ` z f 6XI <br />Phone No. <br />Date <br />Date <br />Updated 6/22/12 5 <br />