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NOTICE OF RESTRICTION OFUSE <br />and Notice of Right to Appeal <br />C', __ 5 ` k v V � <br />DATE: TIME: CASE #: _Tq C) T 013c <br />LOCATION (PAR /OPEN SPACE):,_P L-6 __ ----- — - ------------------------ - - --- - ---------------------------------- <br />Under the authority of. d inistrative 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 of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on yo <br />0.5 - u violated Section L1_Q1_0 ca the Park <br />and Open Space Rules, and/or Section q,' 60 of the Eugene C O <br />ode, 1971, andfor RS To wit, you: <br />jj\__(1Jf6__D YoulllL_ PRJVk_r6_ <br />(Description of the violation.) <br />bf <br />1_j <br />This restriction of use is effective beginning on OS:30) P and shall remain in effect until <br />Ifyou enter in or use any City of Eugene park open space or racility (luring 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 - you are entitled to an i n fortnal hearing to contest this Notice. A. request for an <br />informal hearing must 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 fol.lowing 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 inore than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel invotved 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 />(Signatur deliveruig nofice) <br />I hereby acknowlcdge receipt of the above Notice on the date and time indicated above. <br />(Signature ot'person being, issued the notice <br />Wilke cepy: Pubtic work", Green Copy, File Yellow Copy Report Copy Pmk Co}w_ Recipiei)t (]tAd Copy Officer Arqieal mtice Rev. OFW03 <br />Last <br />Nani - a Fiis <br />�Z­r kJ, � 111e, <br />DOB: <br />6 <br />CN, <br />=7 <br />UA <br />0� <br />Res AddrcsS City <br />State <br />Zip <br />Res, Phone: <br />Work Phone: <br />Under the authority of. d inistrative 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 of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on yo <br />0.5 - u violated Section L1_Q1_0 ca the Park <br />and Open Space Rules, and/or Section q,' 60 of the Eugene C O <br />ode, 1971, andfor RS To wit, you: <br />jj\__(1Jf6__D YoulllL_ PRJVk_r6_ <br />(Description of the violation.) <br />bf <br />1_j <br />This restriction of use is effective beginning on OS:30) P and shall remain in effect until <br />Ifyou enter in or use any City of Eugene park open space or racility (luring 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 - you are entitled to an i n fortnal hearing to contest this Notice. A. request for an <br />informal hearing must 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 fol.lowing 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 inore than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel invotved 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 />(Signatur deliveruig nofice) <br />I hereby acknowlcdge receipt of the above Notice on the date and time indicated above. <br />(Signature ot'person being, issued the notice <br />Wilke cepy: Pubtic work", Green Copy, File Yellow Copy Report Copy Pmk Co}w_ Recipiei)t (]tAd Copy Officer Arqieal mtice Rev. OFW03 <br />