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NOTICE OF RESTRICTION OF USE <br />and Notice (if Right to Appeal <br />'DATF TIME: CASE <br />N ' 5 �0 IIIII, sciii'� <br />1 4 -"2- 1"?, oz-� <br />I,OCATION(PARK,'OPENSPACE). tA-'A tr-,�(--�'-T--6-AJ PA--r,--� <br />A <br />c� <br />Natne: Last First slid <br />C\ IL A <br />D013 = <br />Race S <br />Ad <br />7tt,/i <br />-ILA -------------- - <br />Res.- ddress: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />I I I I III ��� III IIII 111 <br />M y M. f , ' <br />X <br />The basis for this Notice of Restriction of Use is that on u yo violated Section (2 of the Park <br />- - ---,/ d <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or OR —. To wit, you: <br />- A <br />(Description of the violation.) <br />This restriction of use is effective beginning on L) J and shall remain in effect until <br />If you enter in or 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 />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signa of person person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated abovc, <br />o r-J ki i 0 <br />(Signature of person being issued the notice) <br />White Copy; Public Works Creen Cup ", HIC Y el I ow C opy Report Copy Pink Copy! Recipient G old Copy: Of ficer Appc R I no i" Rev- 0,V03 <br />