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LOCATION (PARKJOPEN SPACE) <br />' ck( <br />7 <br />Naim: Last First Middle <br />a, <br />DM <br />Racei'S"� <br />Res- Address: city <br />St :�] <br />State <br />Zip <br />Res. Phone: <br />Work Phone� <br />The basis for this Notice of Restriction of Use is that on 5c�) (I" Park, <br />you violated Section the 1, Q I <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 />This restriction of use is effective beginning on 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 bye <br />(Signature of person igstring/defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of p `son being issued the notice) <br />While Copy: Public Works Green Copy: Fih; Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy. Officer Appeal notice Rev, 04.6 J3 <br />