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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 0q TIME: CASE#: <br />LOCATION (PARK/OPEN SPACE): ,. ----------- <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) <br />This restriction of use is effective beginning on ty�14_7L' and shall remain in effect until � <br />7 <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 />The Division Director shall schedule to time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing, <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 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 />While Copy: Public Works Green Copy File Yellow Copy: Report Copy Pink CopC Recipient Gold Copy: Officer Appeal notice Rm 0403 <br />Name: Last First Middle <br />DOB� <br />Race/Se <br />- nq zu <br />Res, Address: cit�y <br />dip <br />Res. Phane <br />Work Phone <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) <br />This restriction of use is effective beginning on ty�14_7L' and shall remain in effect until � <br />7 <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 />The Division Director shall schedule to time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing, <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 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 />While Copy: Public Works Green Copy File Yellow Copy: Report Copy Pink CopC Recipient Gold Copy: Officer Appeal notice Rm 0403 <br />