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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 63-Z-F 15 TIME: CASE <br />5A5` I N-15 1 <br />LOCATION (PARK/OPEN SPACE): <br />Loc- <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect untilDlY <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 />Now <br />I - 110 [ s keXcl Jim vc: Ul WCC&C11US) Lj 1 1 77vip L 71 Me i equch L 171 17:71 [fig. J-L Me Iniurrild I Itcal I fig LITC ul V is loll L-j 11 M [(-)F W1 unly <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, from the infonnal 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 />C- <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice (.if) the date and time indicated above, <br />(Signature of person being issued the notice) <br />White Copy: Public Works GNuaCopy: HL7 YcHow Copy: Reparl Copy Pink Copy: Recipient G ol d Copy: 0 fti cer Appeal notice Rev. NMI <br />Nanie: Last First Middle <br />DOB: <br />Race. -' <br />'S <br />I,Z <br />A <br />Res. Address: City <br />State <br />Zip <br />Rts Phone. <br />Work Phone <br />- nk� r <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect untilDlY <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 />Now <br />I - 110 [ s keXcl Jim vc: Ul WCC&C11US) Lj 1 1 77vip L 71 Me i equch L 171 17:71 [fig. J-L Me Iniurrild I Itcal I fig LITC ul V is loll L-j 11 M [(-)F W1 unly <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, from the infonnal 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 />C- <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice (.if) the date and time indicated above, <br />(Signature of person being issued the notice) <br />White Copy: Public Works GNuaCopy: HL7 YcHow Copy: Reparl Copy Pink Copy: Recipient G ol d Copy: 0 fti cer Appeal notice Rev. NMI <br />