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NO TICE RESTRICTION US <br />and Notice of (tight to Appeal <br />DATEj TIM : - �.. CASE ft: -3 _ffi <br />The basis for this Notice of Restriction of Use is that on -- violated Section - --- _— of the Park <br />d Open Space Rules, and/or Section of the Eugene Code, 1 971, and/or ORS ,. To wit, yon: <br />( escription of the violation,) <br />This restriction of use is effective beginning o , and shall remain in effect un it <br />I.f 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 />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 8i . s <br />MIS L <br />This N shall rema],n in effect pend <br />This Notice of Exclusion was delivered to the person named at the top of this iit Lice at t e date §,c time shown above by: _ <br />(Signature cif rson issuingf "delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated. above, <br />l gnatrare of °persc�rt bei g ssue the notice) <br />White Copy: Public Works Green Copy: File Yetlory Copy: Report Copy mink Copy: Recipicni Gold Copy Officer Appeal no ice Rev. 04!03 <br />Name: L st first Middle <br />DOB: <br />Ka �e /, <br />w <br />Re& &dress. C.itV <br />Sta - z <br />, <br />R -s. Pho <br />Mork Phone: <br />The basis for this Notice of Restriction of Use is that on -- violated Section - --- _— of the Park <br />d Open Space Rules, and/or Section of the Eugene Code, 1 971, and/or ORS ,. To wit, yon: <br />( escription of the violation,) <br />This restriction of use is effective beginning o , and shall remain in effect un it <br />I.f 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 />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 8i . s <br />MIS L <br />This N shall rema],n in effect pend <br />This Notice of Exclusion was delivered to the person named at the top of this iit Lice at t e date §,c time shown above by: _ <br />(Signature cif rson issuingf "delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated. above, <br />l gnatrare of °persc�rt bei g ssue the notice) <br />White Copy: Public Works Green Copy: File Yetlory Copy: Report Copy mink Copy: Recipicni Gold Copy Officer Appeal no ice Rev. 04!03 <br />