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NOTICE OF RESTRICTION OF USE <br />DATE; <br />TIME: cr/ 0 ' t e �� ' CASE # <br />LOCATION (PARKJOPEN SPACE).- <br />nll I- <br />notified that you are prohibited from (check box): <br />P / Entering in or using all City of Eugene parks, open spaces or facilities. <br />701, <br />'5-1 d ) $- I <br />The basis for this Notice of Restriction of Use is that on Z you violated Section t 016b%l Park <br />e' <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />W fb/wd lAe, C71W Jff <br />(Description of the violation.) <br />This restriction of use is effective beginning on an 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 />(Signature of person issuing/delivering 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 Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal nofice Rm 044)3 <br />Name! Last First Middle <br />D011: <br />I <br />Rage ex: <br />z <br />LQ <br />z <br />Res. Addrem City <br />State <br />Res. Phone: <br />Work Phone: <br />nll I- <br />notified that you are prohibited from (check box): <br />P / Entering in or using all City of Eugene parks, open spaces or facilities. <br />701, <br />'5-1 d ) $- I <br />The basis for this Notice of Restriction of Use is that on Z you violated Section t 016b%l Park <br />e' <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />W fb/wd lAe, C71W Jff <br />(Description of the violation.) <br />This restriction of use is effective beginning on an 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 />(Signature of person issuing/delivering 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 Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal nofice Rm 044)3 <br />