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NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />w � U5
<br />CA S E M
<br />DATF� TIME:
<br />LOCATION WARKY0 PEN SPACE):_
<br />1 0 zsj-
<br />111 the Authority ofAdministrative Order No. 58-03-24-F and Park and Open Space Rule I , t-1.005(3), you are hereby
<br />notified that you are prohihited from (check box):
<br />Entering in or using all City of Eugene parks, open spaces or facilities.
<br />W
<br />Of)
<br />The basis for this Notice of Restriction of Use is that on you violated SeCtiOD of the Park
<br />and Open Space Rules, and/or Section — - — ------------ — of the Eugene Code, 1971, and/or ORS YX--.o PY To wit, you:_
<br />Pasm�,sigD LT i,,, ms i" emL< (srtawo& it pk)ffu�)
<br />Vj I-ES-44:>
<br />(Deseription c�A the violation.)
<br />`i'" is restriction of use is effective beginning on q and shall remain in effect until L
<br />If you enter in or use any C ity o E ugene park, open space or facility during the o f ecti ve peri od o 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, Arequest for an
<br />info al hearing rnust be made in writing and filed with the Parks & Open Space Division Director (, Division Director")
<br />Nvithin 4N hours (exclusive ofA-eekends) ofreceipt 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 riot more than
<br />T hours (exclusive of weekends) of receipt of tile request for hearing. At the infornial hearing the Division Director will only
<br />consider testimony from yen, 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 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 />(Sign3tUre of person issming/delivering notice)
<br />I hereby acknowledge receipt of the above Notice on the date and time indicated above.
<br />()WA-(3L Cki 'C--A96YK
<br />---- - ------- --
<br />(Signature of perqon being issued the notice)
<br />Wh i ke Cojly Ptffil w Works Greco Copy: File Y e I I ow COPY' P epo rt Cc zPy Pink Copy, Recipient Gold Copy Officer Appeal notm Rev, 04403
<br />Nain,e Last Firsi 1 Iddle
<br />DOB:
<br />Race/sex:
<br />7 0
<br />Req, Addresq, itv
<br />�AVF t�g`
<br />4E to
<br />Zip
<br />Res Plicate:
<br />1 0 zsj-
<br />111 the Authority ofAdministrative Order No. 58-03-24-F and Park and Open Space Rule I , t-1.005(3), you are hereby
<br />notified that you are prohihited from (check box):
<br />Entering in or using all City of Eugene parks, open spaces or facilities.
<br />W
<br />Of)
<br />The basis for this Notice of Restriction of Use is that on you violated SeCtiOD of the Park
<br />and Open Space Rules, and/or Section — - — ------------ — of the Eugene Code, 1971, and/or ORS YX--.o PY To wit, you:_
<br />Pasm�,sigD LT i,,, ms i" emL< (srtawo& it pk)ffu�)
<br />Vj I-ES-44:>
<br />(Deseription c�A the violation.)
<br />`i'" is restriction of use is effective beginning on q and shall remain in effect until L
<br />If you enter in or use any C ity o E ugene park, open space or facility during the o f ecti ve peri od o 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, Arequest for an
<br />info al hearing rnust be made in writing and filed with the Parks & Open Space Division Director (, Division Director")
<br />Nvithin 4N hours (exclusive ofA-eekends) ofreceipt 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 riot more than
<br />T hours (exclusive of weekends) of receipt of tile request for hearing. At the infornial hearing the Division Director will only
<br />consider testimony from yen, 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 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 />(Sign3tUre of person issming/delivering notice)
<br />I hereby acknowledge receipt of the above Notice on the date and time indicated above.
<br />()WA-(3L Cki 'C--A96YK
<br />---- - ------- --
<br />(Signature of perqon being issued the notice)
<br />Wh i ke Cojly Ptffil w Works Greco Copy: File Y e I I ow COPY' P epo rt Cc zPy Pink Copy, Recipient Gold Copy Officer Appeal notm Rev, 04403
<br />
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