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LOCATION (PARK/OPEN SPACE):_ WT - P.Ayr/c <br />z <br />Name: Lass First Middle <br />DOB <br />Race,""%ex: <br />Z/ IVY <br />Res. Address: city <br />State <br />I Zip <br />Res. Phone: <br />Work Phone: <br />Il 111111111 1 111 � I I IIII11i; 111111111 111 1 � <br />21 Entering in or using all City of Eugene parks, open spaces or facilities. qjro�' <br />The basis for this Notice of Restriction of Use is that on violated Section <br />the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and,/or ORS To wit, you:_ <br />t FA,,jr CA-)V)e,,J.A1L j PA/W <br />(Description of the violation.) <br />This restricti(im of use is effective beginning on and shall remain in effect until - 7/d <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 />Pp i "M Ing 1777F 57 Maue in 77 ulig 770 ineu TILT Me Parks & Upert 5pace Arivision Uirector k_ <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />t w- <br />Signature of person issuing/delivering notice <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signarnre of person being issued the notice) <br />White Copy! PaNk Works GTc!en Copy: File Yellow Copy] Report Copy Pinsk Copy: Riec i p In t Gold Copy: 0 flicer 4 ,ppc�d nol w c Rev, 04101 <br />