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�NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />LOCATION (PARK,/OPEN SPAC <br />L APP hl YvAA <br />ACC, 11 f A-411- <br />notified that you are prohibitedfrom (check box)- <br />Entering in or using, alt City of Eugene parks, open spaces or facilitij <br />W <br />(Description of the violation.) <br />This restriction of use is effective beginning on - i ffl -1* 1 �, 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 />Pursuant to Park and Open Space Rule R- 1.074 you are entitled to an info al hearing to contest this Notice. request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ( "the Division Director <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing, <br />This Notice shall remain in effect pending any requested hearing, <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by-. <br />M <br />(Signature ol'person issuingMelivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />/A <br />... <br />14 3 L f <br />(Signature of person being issued the notice) <br />,b t I vn ,� <br />-ASE #- I q <br />White Ctypy; Public Works Green Copy: File Yclkm Copy: R�Tort Copy Pink Copy: Rccipicnt Gold Copy. Officer Ap no6cc Rev- (9/03 <br />Marne: Last I YOVX first MIT).^' Middk <br />DOB <br />Race,'S�x: <br />z <br />Res. Address: city <br />State <br />Zip <br />Res, Phone: <br />Work /11011e; <br />notified that you are prohibitedfrom (check box)- <br />Entering in or using, alt City of Eugene parks, open spaces or facilitij <br />W <br />(Description of the violation.) <br />This restriction of use is effective beginning on - i ffl -1* 1 �, 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 />Pursuant to Park and Open Space Rule R- 1.074 you are entitled to an info al hearing to contest this Notice. request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ( "the Division Director <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing, <br />This Notice shall remain in effect pending any requested hearing, <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by-. <br />M <br />(Signature ol'person issuingMelivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />/A <br />... <br />14 3 L f <br />(Signature of person being issued the notice) <br />,b t I vn ,� <br />-ASE #- I q <br />White Ctypy; Public Works Green Copy: File Yclkm Copy: R�Tort Copy Pink Copy: Rccipicnt Gold Copy. Officer Ap no6cc Rev- (9/03 <br />