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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: <br />5y� qm <br />TIME: —1- - S O CASE #. J 5 -( <br />LOCATION (PAR 'OPEN SPACE): <br />—4k( � <br />tf 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 Ok 4 -- of the Park <br />and Open Space Rules, and/or Section 4-,V�-of the Eugene Code, 1971, and/or ORS To wit, you:_ <br />(Description of the violation.) <br />This restrictiou of use is effective beginning on and shall remain in effect until <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 a.n informal hearing to contest this Notice. Arequestfor <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 weekcnds) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, 0 <br />97401 <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more th <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will on <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearin <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 />(Signature of person issuin J� Fr ice) <br />I hereby acknowledge receipt of the ahove Notice on the date and time indicated above. <br />(Signature of person being issued the notiae) <br />White Copy: Public Wu3 Green Copy: Fi1c, Yellow Cupy: Rcrort Copy Pink Copy: Re6picat Gold Copy: Officer Appetil natikx <br />Rev, 04iO3 <br />Name: Last First Middle <br />DOB: <br />Race/Sex: <br />c-15 i v V1_ <br />\5 <br />Res, Address� Citv <br />stat <br />-A <br />Zi <br />Re. Phone: <br />Work Phone. <br />G, C 1 <br />4 i <br />tf 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 Ok 4 -- of the Park <br />and Open Space Rules, and/or Section 4-,V�-of the Eugene Code, 1971, and/or ORS To wit, you:_ <br />(Description of the violation.) <br />This restrictiou of use is effective beginning on and shall remain in effect until <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 a.n informal hearing to contest this Notice. Arequestfor <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 weekcnds) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, 0 <br />97401 <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more th <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will on <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearin <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 />(Signature of person issuin J� Fr ice) <br />I hereby acknowledge receipt of the ahove Notice on the date and time indicated above. <br />(Signature of person being issued the notiae) <br />White Copy: Public Wu3 Green Copy: Fi1c, Yellow Cupy: Rcrort Copy Pink Copy: Re6picat Gold Copy: Officer Appetil natikx <br />Rev, 04iO3 <br />