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NOTICE OF RE STRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME� CASE 9: -N - L3�9jl-- <br />LOCATION ( PARKJOPEN SPACE): FI—qs <br />z <br />Naine: Last First Middle <br />Res. Address: at <br />svite, <br />Zip <br />Aes.'khorie: <br />W one: <br />ork Ph <br />1 0 (?- <br />9 - 7 q Q 0Y <br />UU6 40 _ <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box)- <br />Entering in or using all City or Eugene parks, open spaces or facilities. <br />and Open Space Rules, and/or Section <br />(Description of the violation.) <br />of the Eugene Code, 1971, and/or ORS —. To wit, you: <br />This restriction o use is effective beginning on and shall remai n in effect until <br />If you enter in OT Use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />(SignatifireoUpersod iSSUing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Si nature of person ern <br />g issued the notice) <br />Whin! Copy. Public Works Gyeen Copy: File Yel Copy � Repon C opv Pink Copy� Recipient Gold Copy: Officet Appeal notwe Rev% 04103 <br />