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LOCATION (PARK/OPEN SPACE): <br />7 <br />Narne: Last First Middle <br />11 g 1 1 1 , - <br />� 6A PE T <br />DOB: <br />Race,-' I X: <br />7� <br />Res. Addre City <br />State <br />Zip <br />Res. Phone: <br />W )rk Phone: <br />jq q VTILA& <br />1� Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section 4,7mo - of the Eugene Code, 19`71., andJor ORS —. To wit, y" <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 />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A request for <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director <br />"s vLft,-R"-, Eugime 01 <br />97402, 1 <br />The Division Director shall schedule a time and place for the informal hearing to be conducted which shall be not more th <br />172 hjwa"*xdusi%-Le— I eekends) of receioxt of the re-*uest for hearing At the informal hearing, the Division Director will on <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the inforinal hearin <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 />(Signature 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 />Whnc Copy: Public Warkq Green Capy� Fite. Yet low Copy; Report C opy Pink Copy: Recipient Gold Copy Officer A ppeal notic e <br />Rev- 04iO3 <br />