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No OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE. �D T I M E: CASE #-. <br />I �A - zb <br />LOCATION ( PAR K/OPEN SPACE):_, P C�V- k c ( 5 , z e z — I - <br />111111 1111110 W <br />'�p Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on ­ 0,40 C , you violated Section , 9 of the Park <br />and Open Space Rules, and/or Section Of the Eugene Code, 1971, andlor ORS To wit, you:_ <br />ell K— <br />PO ? <br />q- <br />(Description of the violation.) VV%rXT <br />This restriction of use is effective beginning on-C�AL) I l i�D and shall remain in effect until -Lso�l 6 <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 />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours texclusive of weekends) OfTeCeint of this Notice at the following addrf-,q�,' I Ulft-Rmysev It .1 1 1 1 1 <br />consider t estimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to fl�e <br />incident. The Division Director may exclude anyone., other than you and those presenting te�timony, ftorn the informal hearing. <br />This Notice shall remain in effeet 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 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />-- flj <br />(Signature ol'person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow cupy: Report Copy Pink Copy: Recipient Cold Copy: Officer Appeal notice Rev, 04103 <br />Name: last First Middle <br />DOB: <br />Race,'Sex. <br />AA �- AIC t all:T)i Aw <br />Res, Address: City <br />State <br />mt, <br />Zip <br />Res, Phone: <br />Work Phone: <br />111111 1111110 W <br />'�p Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on ­ 0,40 C , you violated Section , 9 of the Park <br />and Open Space Rules, and/or Section Of the Eugene Code, 1971, andlor ORS To wit, you:_ <br />ell K— <br />PO ? <br />q- <br />(Description of the violation.) VV%rXT <br />This restriction of use is effective beginning on-C�AL) I l i�D and shall remain in effect until -Lso�l 6 <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 />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours texclusive of weekends) OfTeCeint of this Notice at the following addrf-,q�,' I Ulft-Rmysev It .1 1 1 1 1 <br />consider t estimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to fl�e <br />incident. The Division Director may exclude anyone., other than you and those presenting te�timony, ftorn the informal hearing. <br />This Notice shall remain in effeet 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 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />-- flj <br />(Signature ol'person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow cupy: Report Copy Pink Copy: Recipient Cold Copy: Officer Appeal notice Rev, 04103 <br />