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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 3 TIME: —) 9-?q ?A% CASE <br />LOCATION (PARKJOPEN SPACE) 0 <br />notified, that you are, prohibited from (check box): <br />0� Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <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- I .074 you are entitled to an informal hearing to contest this Notice, A request for an <br />informal hearing must be arcade 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 />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: FAe YtAluvv Copy: Rcpon Copy Fink Copy: Rucipient Gold Copy 0M er A ppea l nol ice Rev, 0410 <br />Name: 1,ast First Middle <br />D(-)t <br />LX K A/ <br />2q� <br />P " <br />Res. Address: <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />notified, that you are, prohibited from (check box): <br />0� Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <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- I .074 you are entitled to an informal hearing to contest this Notice, A request for an <br />informal hearing must be arcade 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 />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: FAe YtAluvv Copy: Rcpon Copy Fink Copy: Rucipient Gold Copy 0M er A ppea l nol ice Rev, 0410 <br />