Acknowledgment <br />I (we), the undersigned, hereby acknowledge that I (we) have read the above appeal form, understand the requirements for filing an <br />appeal of a planning director decision, and state that the information supplied is as complete and detailed as is currently possible, to <br />the best of my (our) knowledge. <br />APPELLANT: OM 1V% <br />tic- <br />Name (print): ~ Phone: ✓ "1 J 6 V I <br />Company/Organization: <br />Address: L V W, Ut ~tt p c S <br />Company/Organization: <br />Address: <br />lL L V- W <br />City/State/Zip: E-mail (if applicable): V1 L l -~4 01 fLf~~`i u SL, <br />Phone: ~(1 ° ' ' Fax: <br />IF this appeaC-i rbeing filed by the affected recognized neighborhood association, complete the following: <br />Name of Association: <br />www. eugene-op.gov/planning <br />Planning & Development Updated: October, 2012 <br />Planning Division <br />99 W. 10TH Avenue, Eugene, OR 97401 <br />P 541.682.5377 * F 541.685.5572 Page 2 of 2 <br />APPELLANT'S REPRESENTATIVE: <br />Name (print): (2~kL_k_ y <br />l'~ <br />