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CITY OF SOUTH BEND, INDIANA <br />WORKONE NORTHERN INDIANA FORM <br />Pursuant to Section 2 -83.2 of the South Bend Municipal Code, the <br />Petitioner referred to herein agrees to work with WorkOne Northern <br />Indiana, 851 South Marietta Street, South Bend, Indiana 46601, as a <br />condition of receiving property tax abatement. <br />0 V141- }t ®C lb iNGS -ZC c . <br />Petitioner's Name <br />Ic <br />Agent's Name Acting on Behalf of the Petitioner <br />-Pi9- <br />Contact Persin <br />020 k 5A{ re A/ J77 <br />Street Address <br />SovTy 36�d Zi✓ x{66 d2 <br />City, State, Zip Code IF <br />Business Telephone Number <br />Signatur of P ti ner <br />cc: WorkOne Northern Indiana <br />Chairperson, Community and Economic Development Committee <br />Department of Community and Economic Development <br />City Clerk's Office <br />