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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE. TIME: ASF 3 ra? q <br />IXP C <br />LOCATION (PARK/OPEN SPACE): <br />Xj <br />notified that you are prohibited from (,check box). <br />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 LCL)c. withe Park <br />and Open Space Rules., and/or Section q./ of the Eugene Code, 1971, andJor ORS ---. To wit, you:_ <br />(Description of the violation,) <br />Thk restriction of use is effective beginning on § and shall remain in effect until —YA) <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 arc entitled to an informal hearing to contest this Notice. A request for an <br />informal hearing niust be made in writing and filed with the Parks &- Open Space Division Director ("the Division Directol") <br />within 48 boars (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 GNcnCopy: Filu Yellow C upy Report Copy Pink Copy: Recipient Gold Copy: Officer hp cal notice Rev- (4I03 <br />Natne: Last 4 i Middle <br />Race- x: <br />A <br />_DOB <br />N� A, <br />Res. Addresq: City <br />'State <br />Zip <br />Res. Phone: <br />Work Phone <br />J-) <br />Xj <br />notified that you are prohibited from (,check box). <br />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 LCL)c. withe Park <br />and Open Space Rules., and/or Section q./ of the Eugene Code, 1971, andJor ORS ---. To wit, you:_ <br />(Description of the violation,) <br />Thk restriction of use is effective beginning on § and shall remain in effect until —YA) <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 arc entitled to an informal hearing to contest this Notice. A request for an <br />informal hearing niust be made in writing and filed with the Parks &- Open Space Division Director ("the Division Directol") <br />within 48 boars (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 GNcnCopy: Filu Yellow C upy Report Copy Pink Copy: Recipient Gold Copy: Officer hp cal notice Rev- (4I03 <br />