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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: 0-2 L f 0 CASE <br />LOCATION (PARK/OPEN SPACE): <br />7 <br />Name: Last First lid - 11 - <br />DOB: <br />Race/ Soup - <br />Rts, Addrcss; City <br />A-V — - <br />s tule <br />z <br />-i <br />Red Phone <br />�Vork P1 Wile: <br />Y'D-- <br />notified that you are prohibited from (check box). <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 you violated Section L ovhe Park <br />and Open Space R ulcs, and/or Section 2 - � a I I of the EJCne �, 1971, and/or ORS To wit, you <br />"I 6�f - 3 &� eldLP—L� VAIV 4- j <br />(Description of the violation.) <br />This restriction of use is effective beginning on [ 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 />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 ol'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, ftom 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 />(Signat re o '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 />I'd <br />whiry Copy: Public Works Green Copy! He Yellow copy: Repw Copy Pink. Copy; Rccipicnt Gold Copy: Officer Appta9 nutict Rev. 04M <br />