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NOTICE OF RESTRICTION OF USE <br />DATE: 0 Lf I D 0 <br />and Notice of Right to Appeal <br />TIME: CASE #: <br />LOCATION (PARK/OPEN SP <br />�,"& 610CIAS <br />02 d 6 Ask S f, <br />!�i!llllll'i�'l�i��ill 11111 �l�� 11 1111111 11 �111 11 �11111 111111 ii� 11111 111i jl�l <br />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 on 0qjot3 you violated Section of the Park <br />I Open Space Rules, arill Section — of the Eugene Code, 1971, and/or ORSq 75n y ow— <br />(Description of the violation.) <br />This restriction of use is effective beginning on C 3 <br />�4/0/3 , and shall remain in effect until 6- <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 />0 1 0 lict At s kuxu I ustv V ci I wecKcrl U I I MCIpl, 0 1 Uilc� I �111141CC all Ulu 10HOW it R I r, aut-ile;nn'. 'I CIL, ta"I'livu.,luNgene, i <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 excludeanyone, other than you and those presenting testimony, frorn 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 Notijb at the date and time shown above by: <br />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 `Narks Green Copy: File Yellow Copy Reptnt Copy Pink Copy: Recipient Goid Copy: Officer Appeal notice Rev. 04/03 <br />Nanie: Last F i rs t Piddle <br />DOB <br />R"e'S <br />Res. Address. city <br />State <br />Zip <br />Res, Phone: <br />Work Phone: <br />12.40J T <br />I <br />!�i!llllll'i�'l�i��ill 11111 �l�� 11 1111111 11 �111 11 �11111 111111 ii� 11111 111i jl�l <br />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 on 0qjot3 you violated Section of the Park <br />I Open Space Rules, arill Section — of the Eugene Code, 1971, and/or ORSq 75n y ow— <br />(Description of the violation.) <br />This restriction of use is effective beginning on C 3 <br />�4/0/3 , and shall remain in effect until 6- <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 />0 1 0 lict At s kuxu I ustv V ci I wecKcrl U I I MCIpl, 0 1 Uilc� I �111141CC all Ulu 10HOW it R I r, aut-ile;nn'. 'I CIL, ta"I'livu.,luNgene, i <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 excludeanyone, other than you and those presenting testimony, frorn 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 Notijb at the date and time shown above by: <br />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 `Narks Green Copy: File Yellow Copy Reptnt Copy Pink Copy: Recipient Goid Copy: Officer Appeal notice Rev. 04/03 <br />