BROOKLYN COMMUNITY BOARD 14

FLATBUSHMIDWOOD COMMUNITY DISTRICT

810 East 16th Street Brooklyn, New York 11230

MARTY MARKOWITZ Borough President

ALVIN M. BERK Chairman

SHAWN CAMPBELL District Manager

Petition for Street Closing

PRINT ALL INFORMATION BELOW AND SIGN TO AUTHENTICATE OCCUPANTS CONSENT, FORWARD COMPLETED DOCUMENT TO COMMUNITY BOARD #14. WE, the Undersigned, who reside on _______________________________ between ________________________________________
Name of Street Cross Street Cross Street

and _________________________, hereby support the closure of the above-designated street for the purpose of conducting a Block Party as described below. Day of the Week: Start Time: Date: Completion Time:

To be sponsored by: ______________________________________________________________________________

Print name: Address: Apt. #: Tel. #: Signature:

Print name: Address: Apt. #: Tel. #: Signature:

Print name: Address: Apt. #: Tel. #: Signature:

Print name: Address: Apt. #: Tel. #: Signature:

Print name: Address: Apt. #: Tel. #: Signature:

Print name: Address: Apt. #: Tel. #: Signature:

Falsification and/or duplication of signatures will result in revocation of Community Board 14 approval. Community Board 14 may randomly verify signatures.
PHONE: (718) 859-6357 FAX: (718) 421-6077 E-MAIL: info@cb14brooklyn.com WEB: www.cb14brooklyn.com