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LOCATION (PARKJOPEN SPACE): 1 V ( <br />notified that you are prohibited from (check box) <br />�00 Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 —1 <br />The basis for this Notice of Restriction of Use is that on A you violated Section <br />- ,, — %� Othe Park <br />and Open Space Rules, and./or Section q--11�4— of the Eugene Code, 1971, and/or ORS <br />(_j � t� <br />To wit, you:_ <br />K <br />(Description of the violation.) I C <br />This restriction of use is effective beginning on and shall remain in effect untfl <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 wcond degree. <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) ol'reccipt of the request for hearing, At the informal hearing the Divj:,ion Director will ono <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, fro m 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 />(Signature of'per%oyi issuij ng/delivering noticc) <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 Grucn(:opp: File Yellow Copy: Report Copy Pink Copy! Pecipient Gold C apy : 0 fficer A ppea i notice Rev- 04.103 <br />Name: Lase First Middle <br />:2p <br />DOB: <br />Race/Sex <br />L4 <br />L <br />Lj <br />... ........ <br />Re �., . Address: State <br />Zip <br />Res. Phone: <br />- <br />Work hone: <br />notified that you are prohibited from (check box) <br />�00 Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 —1 <br />The basis for this Notice of Restriction of Use is that on A you violated Section <br />- ,, — %� Othe Park <br />and Open Space Rules, and./or Section q--11�4— of the Eugene Code, 1971, and/or ORS <br />(_j � t� <br />To wit, you:_ <br />K <br />(Description of the violation.) I C <br />This restriction of use is effective beginning on and shall remain in effect untfl <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 wcond degree. <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) ol'reccipt of the request for hearing, At the informal hearing the Divj:,ion Director will ono <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, fro m 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 />(Signature of'per%oyi issuij ng/delivering noticc) <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 Grucn(:opp: File Yellow Copy: Report Copy Pink Copy! Pecipient Gold C apy : 0 fficer A ppea i notice Rev- 04.103 <br />