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DATE: LIS 0) <br />LOCATION (PARK/ PEN SPACE): <br />and Notice of Right to Appeal <br />TIME: <br />CASE #: <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />V <br />(Description of the violation.) <br />This restriction of use is effective beginning on A'Qto and shall remain in effect until' dw <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-1.074 you are entitled to an inforinal hearing to contest this Notice, A request for <br />� ue.st for <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, 0 <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more Ith <br />72 hours Jexclusive of weekcnds�, of recej�xct of ajest for hearin&. At the infortrial hearinm the Division Director will n <br />consider testimony from you, City personnel involve in the incident that resulted in this Notice, and other witnesses to d <br />i <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infori hearin <br />This Notice shall remain in effect pending any requested hearing. 0 <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 person issuing/delivering notice) <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy; Recipient Gold Copy o fficer? ppcal notice Rev. 04/03 <br />NXne Last First mid le <br />DOB <br />Race/ <br />LU <br />Re Address: C' <br />slat <br />Res. Phone: <br />Work Phone: <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />V <br />(Description of the violation.) <br />This restriction of use is effective beginning on A'Qto and shall remain in effect until' dw <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-1.074 you are entitled to an inforinal hearing to contest this Notice, A request for <br />� ue.st for <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, 0 <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more Ith <br />72 hours Jexclusive of weekcnds�, of recej�xct of ajest for hearin&. At the infortrial hearinm the Division Director will n <br />consider testimony from you, City personnel involve in the incident that resulted in this Notice, and other witnesses to d <br />i <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infori hearin <br />This Notice shall remain in effect pending any requested hearing. 0 <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 person issuing/delivering notice) <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy; Recipient Gold Copy o fficer? ppcal notice Rev. 04/03 <br />