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NOTICE OF RESTRICTION OF USE and Notice of Right to Appeal DATE: LOCATION (PARK/OPEN SPACE): TIME: CASE #: Under the authority of Administrative Order No. 58 -03 -_ and Park and Open Space Rule R- 1.005(3), you are hereby notified that you are prohibited from (check box): ❑ Entering in or using all City of Eugene parks, open spaces or facilities, or from participation in any City sponsored programs or activities. ❑■ The basis for this Notice of Restriction of Use is that on , you violated Section of the Park and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS . To wit, you: (Description of the violation.) This restriction of use is effective beginning on , and shall remain in effect until If you enter in or use any City of Eugene park, open space, facility or attempt to participate in a City- sponsored recreation program or activity during the effective period of this Notice, you may be arrested and charged with criminal trespass in the second degree. 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 informal hearing must be made in writing and filed with the Parks & Open Space Division Director within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR 97402. The Parks & Open Space Division Director ( "the Division Director ") shall schedule a time and place for the informal hearing to be conducted, which shall be not more than 72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only consider testimony from you, City personnel involved in the incident the resulted in this Notice, and other witnesses to the incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. This Notice shall remain in effect pending any requested hearing. This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: (Signature of person issuing/delivering notice) I hereby acknowledge receipt of the above Notice on the date and time indicated above. (Signature of person being issued the notice) White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 Name: Last First Middle DOB: Race /Sex: U Res. Address: City State Zip Res. Phone: Work Phone: Under the authority of Administrative Order No. 58 -03 -_ and Park and Open Space Rule R- 1.005(3), you are hereby notified that you are prohibited from (check box): ❑ Entering in or using all City of Eugene parks, open spaces or facilities, or from participation in any City sponsored programs or activities. ❑■ The basis for this Notice of Restriction of Use is that on , you violated Section of the Park and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS . To wit, you: (Description of the violation.) This restriction of use is effective beginning on , and shall remain in effect until If you enter in or use any City of Eugene park, open space, facility or attempt to participate in a City- sponsored recreation program or activity during the effective period of this Notice, you may be arrested and charged with criminal trespass in the second degree. 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 informal hearing must be made in writing and filed with the Parks & Open Space Division Director within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR 97402. The Parks & Open Space Division Director ( "the Division Director ") shall schedule a time and place for the informal hearing to be conducted, which shall be not more than 72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only consider testimony from you, City personnel involved in the incident the resulted in this Notice, and other witnesses to the incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. This Notice shall remain in effect pending any requested hearing. This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: (Signature of person issuing/delivering notice) I hereby acknowledge receipt of the above Notice on the date and time indicated above. (Signature of person being issued the notice) White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03