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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE TIME: CASE <br />C) V" <br />LOCATION (PARK / }PEN SPACE):__ AAAM1)k- )4P'Mj <br />III <br />i q <br />iiii 1111IF! VII! 11 1 1 1 11 1FINTRIM 1 11; !II! IRS � III <br />2� 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 tart s u violated Section fthe Park <br />and Open Space Rules, and/or Section V� F( 71 — of the Eugene Code, 197 1, and/or ORS To wit, you: <br />(Description of the '6olation. ) <br />This restriction of use is effective beginning on <br />Al 1 L , and s ha 1I remain in effect until <br />12 nours (,exclusive or weeKenusJ or jecelpf ol Me requesf U51 577fing. 777ne imonnal nearing Ene 1717131011 Jilreclur <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />i ncident. The Division Director may exclude anyone, other than you and those presenting testi morly, from the informal hearing. <br />This Notice shall remain in eMet pending any requested hearing. <br />This Notice or Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature olperson 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 />Whke Cnpy: Piiblw iirk Grcm Copy� He Yellow copy: Report Copy Pink Copy: Recipient Gold Copy. Ofricur Appent notice Rev- 4S 03 <br />Name: Last First lickile <br />0011 <br />Race!Sex <br />5 — TcNerl � <br />Res. Address City <br />State <br />I <br />Zip <br />Res. Phone: <br />Work Phont, <br />7 &,j ) f A­J,'�' <br />III <br />i q <br />iiii 1111IF! VII! 11 1 1 1 11 1FINTRIM 1 11; !II! IRS � III <br />2� 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 tart s u violated Section fthe Park <br />and Open Space Rules, and/or Section V� F( 71 — of the Eugene Code, 197 1, and/or ORS To wit, you: <br />(Description of the '6olation. ) <br />This restriction of use is effective beginning on <br />Al 1 L , and s ha 1I remain in effect until <br />12 nours (,exclusive or weeKenusJ or jecelpf ol Me requesf U51 577fing. 777ne imonnal nearing Ene 1717131011 Jilreclur <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />i ncident. The Division Director may exclude anyone, other than you and those presenting testi morly, from the informal hearing. <br />This Notice shall remain in eMet pending any requested hearing. <br />This Notice or Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature olperson 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 />Whke Cnpy: Piiblw iirk Grcm Copy� He Yellow copy: Report Copy Pink Copy: Recipient Gold Copy. Ofricur Appent notice Rev- 4S 03 <br />