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and Notice of Right to Appeal <br />DATE 0 TIME: -A��)�. CASE #-. <br />t 2 - 3 o ss <br />11- 05A176 <br />LOCATION (PARK/OPEN SPACE): — E Y- — Ate <br />The basis for this Notice of Restriction of Use is that on — , V5 � -�) "vou violated Section of the Park <br />—DSpa <br />and Open Space Rules, and/or Section � 3 QL_ of the Eugene Code, 1971, and/or OR — o To wit, you:_ <br />2,J <br />(Description of the violation.) <br />This restriction of use is effective beginning on (5 1, 5, and shall remain in effect untilO ZZ(3 <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 (exclusive of weekends) ofreceipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will only <br />'der testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />consl <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from 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 />q-Akj W�3 <br />--,n4— <br />ure <br />(signature ofp son issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />White Copy: Public Works Green Copy: File YeHow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev 04M3 <br />Name: M First Middle <br />DOB: <br />Race /Se <br />OG- <br />Res. ddregs: City State <br />Zip <br />Res. Phone: <br />Work Phone: <br />The basis for this Notice of Restriction of Use is that on — , V5 � -�) "vou violated Section of the Park <br />—DSpa <br />and Open Space Rules, and/or Section � 3 QL_ of the Eugene Code, 1971, and/or OR — o To wit, you:_ <br />2,J <br />(Description of the violation.) <br />This restriction of use is effective beginning on (5 1, 5, and shall remain in effect untilO ZZ(3 <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 (exclusive of weekends) ofreceipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Director will only <br />'der testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />consl <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from 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 />q-Akj W�3 <br />--,n4— <br />ure <br />(signature ofp son issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />White Copy: Public Works Green Copy: File YeHow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev 04M3 <br />