Acknowledgment <br />I(we),theundersigned,herebyacknowledgethatI(we)havereadtheaboveappealform,understandtherequirementsforfilingan <br />appealofaplanningdirectordecision,andstatethattheinformationsuppliedisascompleteanddetailedasiscurrentlypossible,to <br />thebestofmy(our)knowledge. <br />APPELLANT: <br />Phone: <br />Name(print): <br />Company/Organization: <br />Address: <br />City/State/Zip: <br />Signature: <br />REPRESENTATIVE: <br />Name(print): <br />Company/Organization: <br />Address: <br />Email(ifapplicable): <br />City/State/Zip: <br />Phone:Fax: <br />Signature: <br />IF thisappealisbeingfiledbytheaffectedrecognizedneighborhoodassociation,completethefollowing: <br />NameofAssociation: <br />www.eugene-or.gov/planning <br />Planning&DevelopmentUpdated:October,2012 <br />PlanningDivision <br />TH <br />99W.10Avenue,Eugene,OR97401 <br />P541.682.5377*F541.685.5572Page 2 of 2 <br /> <br />