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F ENTERED <br />ROUTED BY: 801 CAD #: 29037 - F CUSTODY <br />. Pat Assign <br />OTHER: <br />CHARGE: <br />CASE #: 1 3, - 5472 <br />F LODGED C M 1 CP I F J <br />Viol Park Rules <br />0 Interpreter 4D31 Interpreter No. –65q Page – I — of _ <br />OREGON UNIFORM CITATION AND COMPLAINT . c cn . <br />CRIMINAL MANDATORY APPEARANCE (SEE BACK.) NON- TRAFFIC -.t, C4 j <br />0 VIOLATION 0 OPTIONAL APPEARANCE (SEE BACK.) 0 TRAFFIC <br />STATE OF OREGON p Municipal - 1102 Lincoln St. 0 Juvenile -2727 Centennial Blvd. <br />CITY OF EUGENE /U Circuit-125 E. 8th Ave. See (Reverse Side.) Zip: 97401 <br />COUNTY OF LANE 0 Other court, see below <br />_ <br />653674 <br />sbelton tarnbail EUGENE, OR (541) 687 -1214 • 1- 800 - 543-9062 <br />A THEUNDERSIGNED CERTIFIES "AND SAYS THAT , t . rt - :_ <br />-- <br />;'. <br />FIRST MIDDLE <br />NAME. LAST <br />f M •J G%�IiLC 17=� /� <br />- <br />", <br />PHONE <br />ADDR <br />- <br />`- <br />kT <br />CITY <br />STATE <br />ZIP <br />' <br />`rn <br />SSN OR OTHER ID EMPLOYMENT /SCHOOL <br />. <br />_ L <br />G �STATE� <br />0 EMPLOYED TO DRIVE <br />DRIVER LICENSE NO. <br />; <br />_ Giro 0 PASSENGER <br />�� <br />GATE OF BIRTH RACE SEX HEIGHT WEIGHT HAIR EYES <br />WING TIME AND PLACE IN, THE ABOVE,MENTIONED:STATEAND COUNTY: ^. <br />ATT. _FOLLO O <br />pqy YEAR - TIME AM <br />r. <br />';•� <br />OFFENSE DATE MONTH / q •PM <br />ON OR ABOUT:K / 1 <br />D <br />AT OR NEAR LOCATION: - <br />" " EON.A,HIGHWAY/ PREMISES .OP_.EN.TO,ThiE�PUBLIC:" <br />DID'OPERATEITHE FOLLOWINGVEHICL <br />VEHICLE LICENSE N0. - STATE O DRIVER NOT ACCIDENT: O PERSONAL INJURY <br />.. <br />,♦�. <br />REG. OWNER 0 PROPERTY DAMAGE .. <br />_' <br />VEH.YR. MAKE MODEL STYLE COLOR <br />n <br />r <br />'m <br />PEDESTRIAN HAZ MAT <br />PUC NO. <br />po BICYCLE CDL RELATED <br />- .DID, THEN AND THERE; COMMITTHE.FOLL'OWING OFFENSES) <br />0 VIO. BASIC RULE ALLEGED SPD ZONElPS1'D SPD © LIDAR <br />1 VIOLATED <br />(CITE ORS/ O VIO. DES SPD 0 PACE <br />ORD.RULE) • (] PRES. FINE/SEC. <br />CHARGE, <br />V10-' , 1Ti2-i C= PB =X /Zr�c%S L(:t<C1r�1/ �c'Sc Zw <br />_171 2. VIOLATED CHARGE <br />nl (CITE ORS/ <br />Z OF D.RULE) PRES. FINE SEC. <br />m <br />. 3. VIOLATED CHARGE - <br />;' (CITE ORS/ <br />' "'D RULE) <br />PRES. FINE/SEC. <br />`. I CERTIFY UNDER ORS 153.045 AND 153.990 THAT 1 HAVE SUFFICIENT GROUNDS TO AND DO BELIEVE THAT THE ABOVE <br />'A AND I HAVE SERVED THE PERSON WITH THIS COMPLAINT, <br />MENTIONED PERSON COMMITTED THE OF <br />03 22 2>r3 `2 i . <br />OFFICER IGNATURE OFFICER ID <br />DATE ISSUED � _ <br />tea❑ "bOMPL:4INTYINFORMATION <br />; FILED AT TIME OF CITATION <br />D <br />NAME OF ARRESTING PERSON, IF NOT OFFICER - <br />7oUR :000RTA0PEA_RANCE:DATETIME ANDLOCATION,,-' <br />MO J -n D TIME M AM LOCATION (IF NOT LISTED ABOVE) <br />X PM <br />0 Interpreter 4D31 Interpreter No. –65q Page – I — of _ <br />OREGON UNIFORM CITATION AND COMPLAINT . c cn . <br />CRIMINAL MANDATORY APPEARANCE (SEE BACK.) NON- TRAFFIC -.t, C4 j <br />0 VIOLATION 0 OPTIONAL APPEARANCE (SEE BACK.) 0 TRAFFIC <br />STATE OF OREGON p Municipal - 1102 Lincoln St. 0 Juvenile -2727 Centennial Blvd. <br />CITY OF EUGENE /U Circuit-125 E. 8th Ave. See (Reverse Side.) Zip: 97401 <br />COUNTY OF LANE 0 Other court, see below <br />_ <br />653674 <br />sbelton tarnbail EUGENE, OR (541) 687 -1214 • 1- 800 - 543-9062 <br />