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C <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: fl <br />_Qf�j TIME: <br />CASE#a _1 4 — <br />_. <br />LOCATION (PARK/OPEN SPACE): 61J0_ <br />J W Entering in or using all City of Eugene parki, open spaces or faciliti(I <br />X <br />(Description of the violation.) <br />This restriction of use is effective beginning on 6 1r1 —, and shall remain in effect until <br />If you enter in or use any City of Eugene park, open space or facility during the of period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree, <br />The Division Director shall schedule a 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 />FiAd v i �zo <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 />White Copy: Public Works Green Copy: File YeHow Copy: Report Copy Pink Cupy: Recipient Gold Copy: Officer Appeal notice Rev- N/03 <br />Narrle� Last First Middle <br />DOB: <br />Race Sex: <br />S <br />as <br />Res, Address: City <br />Stale <br />Zip <br />Res. Phone: <br />Work Phone <br />J W Entering in or using all City of Eugene parki, open spaces or faciliti(I <br />X <br />(Description of the violation.) <br />This restriction of use is effective beginning on 6 1r1 —, and shall remain in effect until <br />If you enter in or use any City of Eugene park, open space or facility during the of period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree, <br />The Division Director shall schedule a 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 />FiAd v i �zo <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 />White Copy: Public Works Green Copy: File YeHow Copy: Report Copy Pink Cupy: Recipient Gold Copy: Officer Appeal notice Rev- N/03 <br />