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� v j ' Al��r Na ICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE <br />TIME: CASE ft: <br />LOCA (PARK-OPEN SPACE): <br />— <br />Under 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 />Entering in or using all City or Eugene parks, open spaces or facilities. <br />X <br />The basis for this Nonce of Restriction of Use is that on. you violated, Sectioll of the Park <br />N <br />a C <br />and Open Space Rules, and/or Section --- of Eugene ode, 1971, and/or ORS V - 2 y 7 Uqo wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall rernain 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 inforrnal hearing to contest this Notice. Arequest fear an <br />informal hearing must be rnadc in writing and filed with the Parks & Open Space Division Director (, Division Director") <br />within 48 hours (exclusive of weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedLdc 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 Drvisiork Director will onh <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnc. 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 data and time shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above, <br />(Signature of person being issued the notice) <br />White Copy � Public Wor Green(Apyt Fide Yellow ('opy: Report Copy mirk C opy Recipient Gold Copy: 0 M ccr Appeal not i c o Ro s - 041!0! <br />if, -';-' F j r , , Clw . i F,,� <br />Name: Last Middle <br />D0132 1 <br />Raee/Sex� <br />1, ­0 4 1 <br />I - ­. <br />Res Adclrc C <br />il P <br />Res. Phone� <br />Work Phone.� <br />Under 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 />Entering in or using all City or Eugene parks, open spaces or facilities. <br />X <br />The basis for this Nonce of Restriction of Use is that on. you violated, Sectioll of the Park <br />N <br />a C <br />and Open Space Rules, and/or Section --- of Eugene ode, 1971, and/or ORS V - 2 y 7 Uqo wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall rernain 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 inforrnal hearing to contest this Notice. Arequest fear an <br />informal hearing must be rnadc in writing and filed with the Parks & Open Space Division Director (, Division Director") <br />within 48 hours (exclusive of weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedLdc 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 Drvisiork Director will onh <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnc. 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 data and time shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above, <br />(Signature of person being issued the notice) <br />White Copy � Public Wor Green(Apyt Fide Yellow ('opy: Report Copy mirk C opy Recipient Gold Copy: 0 M ccr Appeal not i c o Ro s - 041!0! <br />