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NOTICE OF RESTRICTION OF US' <br />and Notice of Right to Appeal <br />DATE: TIME: CASE #: <br />LOCATION (PARKJOHN <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on 12_ _2DL� , you violated Section of the Park <br />and Open Space Rules, and/or Section ofthe Eugene Code, 1971, and/or ORS To wit, you:_ <br />e <br />(Description of the violationI <br />This restriction of use is effective beginning on 4OD—d—, and shall remain in effect until <br />If you enter in or use any Ci of Eugene park, open space or facility during the effective period o this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule It -1.074 you are entitled to an info al hearing to contest this Notice. A request for an <br />info al 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 />"IVIIIILHIJ-Mu�l la i scileu L1111C MIU P L- U� U—�U�— <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infori hearing the Division, Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other w itnesses 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 N e date and time shown above by: <br />(Signature 4()fpson issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />person Ibein8 issued the notice) <br />White Copy: Public Works Green Copv: File Yellow CcTy: Report. Copy Pink Copy! Recipient Gold Cvpy� Officer Appeal notice Ret 04103 <br />Name: Last First Middle <br />DOB: <br />Race/sex. <br />0 7 /? 7 9 <br />Res. Address: City <br />tat, <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />P AN <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on 12_ _2DL� , you violated Section of the Park <br />and Open Space Rules, and/or Section ofthe Eugene Code, 1971, and/or ORS To wit, you:_ <br />e <br />(Description of the violationI <br />This restriction of use is effective beginning on 4OD—d—, and shall remain in effect until <br />If you enter in or use any Ci of Eugene park, open space or facility during the effective period o this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule It -1.074 you are entitled to an info al hearing to contest this Notice. A request for an <br />info al 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 />"IVIIIILHIJ-Mu�l la i scileu L1111C MIU P L- U� U—�U�— <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infori hearing the Division, Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other w itnesses 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 N e date and time shown above by: <br />(Signature 4()fpson issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />person Ibein8 issued the notice) <br />White Copy: Public Works Green Copv: File Yellow CcTy: Report. Copy Pink Copy! Recipient Gold Cvpy� Officer Appeal notice Ret 04103 <br />