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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE#: V76 S" <br />LOCATION (PARK/OPEN SPACE).__AAJ411�K <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 be I t s' you violated Section 1.0, ii� 0 e Park <br />and Open Space Rules, andJor Section of the Eugene Code, 1471, andJor ORS To wit, you: <br />(Description of the violation.) I <br />This restriction of use is effective beginnin and shall remain in effec g on - 3 15�La ace until t <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 an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt ofthis Notice at the following address: 1920 Roosevelt, Blvd., Eugene, OR <br />97402. <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 />White Copy: Pubk Works Gruen Copy! File Vdlow Copy! Report Copy Pink Copy Recipient Gold Copy: 0 ffi cer Appea I notice Rev. 04M <br />Name: Last First Middle <br />DOB: <br />Raco,'Se <br />�z <br />q -73 <br />Lh, <br />Res. Address: city <br />State <br />Zip <br />Res, Phone: <br />Work Phone: <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 be I t s' you violated Section 1.0, ii� 0 e Park <br />and Open Space Rules, andJor Section of the Eugene Code, 1471, andJor ORS To wit, you: <br />(Description of the violation.) I <br />This restriction of use is effective beginnin and shall remain in effec g on - 3 15�La ace until t <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 an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt ofthis Notice at the following address: 1920 Roosevelt, Blvd., Eugene, OR <br />97402. <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 />White Copy: Pubk Works Gruen Copy! File Vdlow Copy! Report Copy Pink Copy Recipient Gold Copy: 0 ffi cer Appea I notice Rev. 04M <br />