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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE-. TME: - JLS�, CASE #: /3- <br />LOCATION (PARKJOPEN <br />Uuder the authority of Administrative Order No. 58-03-24-F a id Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />)A Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on _05 - <br />you violated Section - 10 /Q Q of the Park <br />and Open Space Rules, and/or Section _, AQ of the Eugene Code, 1971, andhor ORS To wit, you: <br />1A.' w4c 0 C,5 r 644- 2 <br />LE-uS -L <br />(Description of the violation.) <br />This restriction of use is effective beginning an and shall remain in effect until nC, <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 informal 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 6exelusive of weekends) of recei�t of this Notice at the followin address: 1820 Roosevelt, Blvd., Eug-LiIL�,, OR <br />97402. <br />This Notice of Exclusion was delivered to the person named at the top of this No/iMt the data and time shown above by: <br />M <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: Puhliv Works Greco Copy: He YcHow copy_ Report Copy Pink Copy: Recipient Gold Copv! OfficeT Appeal notice Rev, OW03 <br />Nanie: Las! First Middle <br />DOB: <br />Race,SeN: <br />Res. Addrew City <br />stale <br />Zip <br />Res, Phone: <br />NV,,,k- Ph, �,,. <br />Uuder the authority of Administrative Order No. 58-03-24-F a id Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />)A Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on _05 - <br />you violated Section - 10 /Q Q of the Park <br />and Open Space Rules, and/or Section _, AQ of the Eugene Code, 1971, andhor ORS To wit, you: <br />1A.' w4c 0 C,5 r 644- 2 <br />LE-uS -L <br />(Description of the violation.) <br />This restriction of use is effective beginning an and shall remain in effect until nC, <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 informal 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 6exelusive of weekends) of recei�t of this Notice at the followin address: 1820 Roosevelt, Blvd., Eug-LiIL�,, OR <br />97402. <br />This Notice of Exclusion was delivered to the person named at the top of this No/iMt the data and time shown above by: <br />M <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: Puhliv Works Greco Copy: He YcHow copy_ Report Copy Pink Copy: Recipient Gold Copv! OfficeT Appeal notice Rev, OW03 <br />