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Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule 1 -14005(3), you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on You violated Section _ �r � st ° the Park <br />and Open Spoce Rules, and/or Section k of the Eugene (..ode, 1971, and/or OR To wit, you� <br />Signature of person issuing/delivering notice <br />C, L� <br />I hereby acknowledge TeCeipt of the above Notice on the date and thue indicated above, <br />(Signature of person being issued the notice) <br />whi�e ( oily Public WAA'N Grecri Copy Nle Yelhm Copy: Rcpod Copy Pink Copy: Rmpiejil Gold Copy! Offixei Appeal n4,fice RC, 04 U"' <br />Name: Last First Middle <br />1)013' <br />Raceis X. <br />17) 7 <br />Res, Addresq� City <br />State <br />Zip <br />Res" Phone <br />Wotk Phoiie� <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule 1 -14005(3), you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on You violated Section _ �r � st ° the Park <br />and Open Spoce Rules, and/or Section k of the Eugene (..ode, 1971, and/or OR To wit, you� <br />Signature of person issuing/delivering notice <br />C, L� <br />I hereby acknowledge TeCeipt of the above Notice on the date and thue indicated above, <br />(Signature of person being issued the notice) <br />whi�e ( oily Public WAA'N Grecri Copy Nle Yelhm Copy: Rcpod Copy Pink Copy: Rmpiejil Gold Copy! Offixei Appeal n4,fice RC, 04 U"' <br />