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Block Party Request Form (updated 05-11-21)John D. Ryan Mayor Renee N. Harding Clerk and Collector Trustees Richard S. Dalzell Monica M. Juarez- Mendoza Christine L. McLawhorn Christopher W. Murphy Catalina Nava-Esparza David A. Perretta BLOCK PARTY REQUEST We the undersigned residents of: _______________________________________________________ Petition the Village Board of Alsip for permission to block our street from traffic flow on: ___________ ____________________________, 20__________, between the hours of: ________________________ For the purpose of a: Block Party”. PLEASE CHECK ONE: WE will need barricades ______ WE will NOT need barricades_______ PLEASE CIRCLE ONE: We want Fire Department to come out. (If available) YES NO PLEASE CIRCLE ONE: We want Police Department to come out. (If available) YES NO PLEASE CICRLE ONE FOR EACH: We will have a DJ YES NO WE will have a Live Band YES NO NAMES, ADDRESSES AND SIGNATURES: 1____________________________________________________________________________________ 2____________________________________________________________________________________ 3____________________________________________________________________________________ 4____________________________________________________________________________________ 5____________________________________________________________________________________ 6____________________________________________________________________________________ 7____________________________________________________________________________________ 8____________________________________________________________________________________ 9____________________________________________________________________________________ 10___________________________________________________________________________________ 11___________________________________________________________________________________ 12___________________________________________________________________________________ 13___________________________________________________________________________________ PERSON TO CONTACT_____________________________ PHONE_______________________________ ADDRESS_____________________________________________________________________________ 4500 West 123rd Street • Alsip, Illinois 60803-2599 • Phone 708-385-6902 • Fax 708-385-9561 14___________________________________________________________________________________ 15___________________________________________________________________________________ 16___________________________________________________________________________________ 17___________________________________________________________________________________ 18___________________________________________________________________________________ 19___________________________________________________________________________________ 20___________________________________________________________________________________ 21___________________________________________________________________________________ 22___________________________________________________________________________________ 23___________________________________________________________________________________ 24___________________________________________________________________________________ 25___________________________________________________________________________________ 26___________________________________________________________________________________ 27___________________________________________________________________________________ 28___________________________________________________________________________________ 29___________________________________________________________________________________ 30___________________________________________________________________________________ 31___________________________________________________________________________________ 32___________________________________________________________________________________ 33___________________________________________________________________________________ 34___________________________________________________________________________________ 35___________________________________________________________________________________ 36___________________________________________________________________________________ 37___________________________________________________________________________________ 38___________________________________________________________________________________ 39___________________________________________________________________________________ 40___________________________________________________________________________________ 41___________________________________________________________________________________ 42___________________________________________________________________________________ 43___________________________________________________________________________________ 44___________________________________________________________________________________ 45___________________________________________________________________________________