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7 <br />notified that you are prohibited from (check box): <br />N4 Entering in or using all, City of Eugene parks, open spaces or facilities. <br />NO <br />The basis for this Notice of Restriction of Use is that on 00--1 you violated Section L. _15-12—ctil of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you. <br />LWE f FI - <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until I j <br />Ifyou enter in or use any City of Eugene park opcir 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 1 41.074 you are entitled to an informal hearing to contest this Notice, A 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 ot'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 inure than <br />72 hours (exclusive of weekends) of - receipt of the request for hearing. At the ird'ormal hearing the Division Director will only <br />consider testimony frorn 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 info rma I 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 to and time shown above by-, <br />(Signature ol'person Issuing./deliverinc, notice) <br />C. <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />__ <br />(SignatUrC of person being issued the notice,) <br />whjie COPY: Pub] [C wurk� Green Copy: File Yellow Copy; Re Port C opy Pink Copy: Rceipient Wd Copy: Officer Appeal notice Rev, 04M I <br />Name: Last First Middle <br />DOB � <br />Race 'Sex: <br />00-c" Ic <br />Res. Address� City <br />Slat <br />State <br />Zip <br />Res, Ph on <br />Wo Phone- <br />7 <br />notified that you are prohibited from (check box): <br />N4 Entering in or using all, City of Eugene parks, open spaces or facilities. <br />NO <br />The basis for this Notice of Restriction of Use is that on 00--1 you violated Section L. _15-12—ctil of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you. <br />LWE f FI - <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until I j <br />Ifyou enter in or use any City of Eugene park opcir 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 1 41.074 you are entitled to an informal hearing to contest this Notice, A 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 ot'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 inure than <br />72 hours (exclusive of weekends) of - receipt of the request for hearing. At the ird'ormal hearing the Division Director will only <br />consider testimony frorn 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 info rma I 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 to and time shown above by-, <br />(Signature ol'person Issuing./deliverinc, notice) <br />C. <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />__ <br />(SignatUrC of person being issued the notice,) <br />whjie COPY: Pub] [C wurk� Green Copy: File Yellow Copy; Re Port C opy Pink Copy: Rceipient Wd Copy: Officer Appeal notice Rev, 04M I <br />