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NOTICE OF RESTRIC'nON OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE <br />LOCATION (PARK/OPEN SPACE): V <br />z <br />Narne: Last First Middle <br />H l <br />Lj C 4)d <br />DOB- <br />Race/sek <br />Res, Address: City State <br />Zip <br />Res. Phone: <br />Work Phone: <br />1111111 ! 1111111 ill 11 11 11111111 p11111111 11 pij�111111' 1� 11 111111 11111111 11111111 �iiiii !1111111 11111111 11 11111111 1 11 1 1 � <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis !or this Notice of Restriction of Use is that on you violated Section _J C ( � <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS LL To wit, you <br />(Description of the violation.) <br />em <br />This restriction of nd shall r ain in effect until use is effective beginning on ffln I �� <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 />wunin 4 nours �exctusl CHU, 01 recel once c a <br />97402. <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 />Y,e -- <br />g i2gv notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of per on being issued the notice) <br />whits Copy: hblic. Works Green Copy! File Yellow Copy: Report Copy Pink Copy Recipient G ol d Copy: Officer Appeal ni ot ice Rev, 04103 <br />