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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: 7 0)_I_ CAS E <br />LOCATION (PARK/OPEN SPACE):1 -A C-5 <br />L <br />notified that you are prohibited from (check box)- <br />2K.- Entering in or using ail City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on '7 you violated Section I 10 1 of the Pwk <br />and Op en Space Rules, and/or Section 1 9 <br />p of the E ugene Code, 1971 and/or OR To wit, you: -QZ6 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 51 <br />, and shall rernain 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 r entitled to an informal hearing to contest this Notice. A request for an <br />info gal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Dircctof')l <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />rut <br />-371,71on Tj[recrorsna s c U e a urne ana place Yor Tne in orma W M t I <br />72 hour% (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will on <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />to <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infornial hilearin <br />'rhis Notice shall rernain in effect pending any requested hearing. <br />This Notice of EXCIUSion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(5ignature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Whi Copy - Pubic Warks Green Copy� File 'i'dow Copy: Repork Cupy Pink Copy! Rcc ipient Maid Car�y! Officcr Appeil notice Rev- W103 <br />lb anie: Last First Middle <br />DOB: <br />Sex� <br />Res Adclress City <br />S U 1 1 <br />Zip <br />Res. Phone: <br />Work Phune: <br />L <br />notified that you are prohibited from (check box)- <br />2K.- Entering in or using ail City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on '7 you violated Section I 10 1 of the Pwk <br />and Op en Space Rules, and/or Section 1 9 <br />p of the E ugene Code, 1971 and/or OR To wit, you: -QZ6 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 51 <br />, and shall rernain 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 r entitled to an informal hearing to contest this Notice. A request for an <br />info gal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Dircctof')l <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />rut <br />-371,71on Tj[recrorsna s c U e a urne ana place Yor Tne in orma W M t I <br />72 hour% (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will on <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />to <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infornial hilearin <br />'rhis Notice shall rernain in effect pending any requested hearing. <br />This Notice of EXCIUSion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(5ignature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Whi Copy - Pubic Warks Green Copy� File 'i'dow Copy: Repork Cupy Pink Copy! Rcc ipient Maid Car�y! Officcr Appeil notice Rev- W103 <br />