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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: <br />TIME: I <br />CASE # <br />LOCATION (PARK/OPEN SPACE); <br />11111 1 1111 ;11 il]" 11111 1 i 1 11111 l pil 1111 1111Z 1111 '111111 1111 IN! I I <br />EM 1� <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 y ou violated Section of the Park <br />and Open Space Rules, andlor Section , qw the Eugene Code, 197t, and/or ORS -. To wit, you <br />(Description of the violation.) <br />This restriction of use is efftctive beginning on ossi I �t 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 informal hearing to contest this Notice. A request for an <br />informal hearing ITILISt 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 />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 infornial 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 exclude anyone, other than you and those presenting testimony, from the info. al 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 ahove by- <br />(Signature of person issuingidefivcring notice) <br />I hereby acknowledge receipt of the above Notice on the date and finic indicated above. <br />(Signature of person being issued the notice) <br />W ft� Cupy: Public WEwks Cyreen Copy File Yellow Copy; Rxport Copy Pink Copy : Recipient Gold Copy. Officer ApVeM notice Rev 04/03 <br />Name: Last First -Middle <br />DOB: <br />le3 <br />l( <br />Ra�:e,/Sex: <br />Ii/Al <br />OIL- <br />Res. Address: city <br />State <br />Zip <br />Rts, Phone: <br />Work Phone: <br />11111 1 1111 ;11 il]" 11111 1 i 1 11111 l pil 1111 1111Z 1111 '111111 1111 IN! I I <br />EM 1� <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 y ou violated Section of the Park <br />and Open Space Rules, andlor Section , qw the Eugene Code, 197t, and/or ORS -. To wit, you <br />(Description of the violation.) <br />This restriction of use is efftctive beginning on ossi I �t 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 informal hearing to contest this Notice. A request for an <br />informal hearing ITILISt 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 />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 infornial 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 exclude anyone, other than you and those presenting testimony, from the info. al 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 ahove by- <br />(Signature of person issuingidefivcring notice) <br />I hereby acknowledge receipt of the above Notice on the date and finic indicated above. <br />(Signature of person being issued the notice) <br />W ft� Cupy: Public WEwks Cyreen Copy File Yellow Copy; Rxport Copy Pink Copy : Recipient Gold Copy. Officer ApVeM notice Rev 04/03 <br />