NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: _U <br />'riw: CASE#: <br />LOCNI'l'ON (PAR /OPEN SPACE): <br />&LIJ <br />Res, Addre Citv <br />13) <br />U nder the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1,005(3), you are hereby <br />notified that you are prohibited from (check box): <br />N --" Entering in or using all City of Eugene parks, open spaces or facilities. <br />N <br />The basis; for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section ofthe Eugene Code, 171, and/or ORS �7 <br />-�, �-o. Y. wit Y ou:_ <br />ril <br />(Description of the violation.) <br />This restriction of use is effective beginning on jb__q 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 trCSPaSS in the second degree. <br />Punsuant to Park and Open Space Rule R -1.074 you are entitled to an informal hearing to contest this Notice. A request f6r an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the, Division Director") <br />within 49 hours (exclusive of weekends) of receipt of this Notice at the follmving address: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedule a firrie and place for the inferential hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ot'receipt of the request for hearing, At the informal 'hearing the Division Director will only <br />consider testiniony from you, City personnel it 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 infoirna) 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 porson <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Si gnature of person being issue( i notice) <br />0, <br />' <br />White Copy: P1311fic ovi Circm CLpy� Fike Ydfovv Copy! Report Cg-aPy Pink Copy: Res ;pent Gold Copy Officer Appeitl antis Rev, W13 <br />Name� Last First Middle <br />Q <br />DOW <br />C C11's Cx <br />Res, Addre Citv <br />13) <br />so <br />tat <br />Zip <br />otc- <br />es—phone: <br />�7vo -- z <br />Work Phone: <br />U nder the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1,005(3), you are hereby <br />notified that you are prohibited from (check box): <br />N --" Entering in or using all City of Eugene parks, open spaces or facilities. <br />N <br />The basis; for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section ofthe Eugene Code, 171, and/or ORS �7 <br />-�, �-o. Y. wit Y ou:_ <br />ril <br />(Description of the violation.) <br />This restriction of use is effective beginning on jb__q 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 trCSPaSS in the second degree. <br />Punsuant to Park and Open Space Rule R -1.074 you are entitled to an informal hearing to contest this Notice. A request f6r an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the, Division Director") <br />within 49 hours (exclusive of weekends) of receipt of this Notice at the follmving address: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedule a firrie and place for the inferential hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ot'receipt of the request for hearing, At the informal 'hearing the Division Director will only <br />consider testiniony from you, City personnel it 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 infoirna) 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 porson <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Si gnature of person being issue( i notice) <br />0, <br />' <br />White Copy: P1311fic ovi Circm CLpy� Fike Ydfovv Copy! Report Cg-aPy Pink Copy: Res ;pent Gold Copy Officer Appeitl antis Rev, W13 <br />