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DATE <br />LOCATION (PARIC/OPEN SPACE): L-0 - J P14 <br />l- <br />Name: Last First Middle <br />1X <br />Race/s�e. <br />ILIA <br />Res. Address: City <br />S tate <br />Zip <br />Res. Phone: <br />Work Phone: <br />V—V Entering in or using all City of Eugene pprks, open spaces or facilities. <br />1 0 <br />The basis for this Notice of Restriction of Use is that on you violated Section bd 14y f the Park <br />and Open Space Rules, and/or Section o the Eugenc Codc, 1971, and/or 0 RS —. To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on (dd , and shall rernain in effect until <br />,b <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.A.074 you are entitled to an informal hearing to contest this Notice. A request for an <br />infornral 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 of this Notice at the following address: 1820 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 tinie indicated above. <br />(Signature ofperson being issued the notice) <br />White copy: Public WOT6 Gicen Copy. Fits: Ye I I ow Copy: ReporL Copy Pink Copy: Recipient Gold Capp Offer A ppual not ice Rev. 04�'03 <br />