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NOTICE OF RESTRICTION OF USE, 5 IA 5 � S\55 <br />and Notice of Right to Appeal <br />DATE: TIME: CASE — #- 5 y <br />j <br />LOCATION (PA RK/OPEN SPACE): <br />The basis for this Notice of Restriction of Use is that on you violated Section40"' of the Park <br />and Open Space Rules, and/or Section _ of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <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 />97402. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date an 'ime shown above by: <br />S � <br />ignature of'person issuing// i - ering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Careen Copy: File Yellow Copy: Rcpori Copy Pink Copy: Recipient G ol d C upy z 0 fficer Appual noeic e Rev- W103 <br />Mine: Last Fiat Mi4ldle <br />DM <br />Res. Address: City <br />State <br />ip <br />Res, Phone: <br />Work Phone: <br />J C"0— -ErRAY Sr fV <br />t� <br />The basis for this Notice of Restriction of Use is that on you violated Section40"' of the Park <br />and Open Space Rules, and/or Section _ of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <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 />97402. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date an 'ime shown above by: <br />S � <br />ignature of'person issuing// i - ering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Careen Copy: File Yellow Copy: Rcpori Copy Pink Copy: Recipient G ol d C upy z 0 fficer Appual noeic e Rev- W103 <br />