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11111 1111111111IIIIII iiiii 11111 . .... 111 101 ii 111111 ! 1 1111 1 1 <br />ffii; VIU111 <br />T1 I <br />K Entering in or using all City of Eugene parks, open spaces or facilities. <br />01 <br />The basis for this Notice of Restriction of Use is that on CS/ you violated Section I.Zic 6) of the Park <br />and Open Space Rules, and/or Section 4f Irt of the Eugene Code, 1971, and/or ORS _. To wit, you; <br />(Description of the violation.) <br />This restriction of use is effective beginning on (X16 a and shall remain in effect until <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 info gal hearing to contest this Notice. A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />1 110"nk; I vquum lux neaTing. 77 me InTormai nea <br />7 Z nours 1,7771.1swe 777 77777711717y III g Me Division L"Jaurk'Jul will <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to tile <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infonnal 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 />White Copy: Public Works Green Copy File Yellow Copy. Report Copy Pink Copy Recipient Gold Copy: Officer Appeal nonce Rev. 04)03 <br />Name: Last First Middle <br />DOB: <br />Race./Sev <br />A-( <br />Res. Address: City <br />State <br />dip <br />Res. Phone: <br />Work Phone: <br />11111 1111111111IIIIII iiiii 11111 . .... 111 101 ii 111111 ! 1 1111 1 1 <br />ffii; VIU111 <br />T1 I <br />K Entering in or using all City of Eugene parks, open spaces or facilities. <br />01 <br />The basis for this Notice of Restriction of Use is that on CS/ you violated Section I.Zic 6) of the Park <br />and Open Space Rules, and/or Section 4f Irt of the Eugene Code, 1971, and/or ORS _. To wit, you; <br />(Description of the violation.) <br />This restriction of use is effective beginning on (X16 a and shall remain in effect until <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 info gal hearing to contest this Notice. A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />1 110"nk; I vquum lux neaTing. 77 me InTormai nea <br />7 Z nours 1,7771.1swe 777 77777711717y III g Me Division L"Jaurk'Jul will <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to tile <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infonnal 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 />White Copy: Public Works Green Copy File Yellow Copy. Report Copy Pink Copy Recipient Gold Copy: Officer Appeal nonce Rev. 04)03 <br />