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NOTICE OF Rps OF USE <br />and Notice of Right to Appeal <br />DATE: q TIME: A) 3& t pA \ <br />CASE #: 13' <br />LOCATION (PARK/OPEN SPACE): <br />III Jill I III I <br />SJ 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 15 __ violated Section 1.0 l Park <br />and Open Space Rules, and/or Section 444 v � of the Eugene Code, 1971„ and/or ORS To wit, you:- <br />(Description of the violation.) <br />Jf <br />This restriction of use is effective beginning on and shall remain in effect until 5h <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-L074 you are entitled to an informal hearing to contest this Notice. A request for art <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 of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />Phis Notice of Exclusion was delivered to the person named at the top of this Notice at the ate and time shown above by: <br />(Signaftilre 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 Cupyi Public Workq Green Copy: File Yellow Copy: Repon Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev, 04,03 <br />Name I <br />First 1i die <br />Do <br />X: <br />TA <br />0AV1 0 <br />Res, Address: <br />City <br />State <br />Zip <br />Re Phone: <br />Work Phone: <br />III Jill I III I <br />SJ 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 15 __ violated Section 1.0 l Park <br />and Open Space Rules, and/or Section 444 v � of the Eugene Code, 1971„ and/or ORS To wit, you:- <br />(Description of the violation.) <br />Jf <br />This restriction of use is effective beginning on and shall remain in effect until 5h <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-L074 you are entitled to an informal hearing to contest this Notice. A request for art <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 of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />Phis Notice of Exclusion was delivered to the person named at the top of this Notice at the ate and time shown above by: <br />(Signaftilre 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 Cupyi Public Workq Green Copy: File Yellow Copy: Repon Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev, 04,03 <br />