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LOCATION (PARK/0PEN SPACE):—Q- ------ ---------------- <br />Under the authority ofAdniinistrative 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 park& open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on5--31 J--I--,you violated Sectionj f the Park <br />and Open Space Rules, and/or Section 41 of the Eugene Code., 1971. and/or ORS To wit, you: <br />-0,,PctA W-TOM4/L JJ K I Lj� PYM � k 7124 0 <br />t <br />(Description of the violation.) <br />This restriction of use is effective heginning on and shall remain in effect untilS3)—/-s <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 info cal hearing to contest this Notice. A request for an <br />informal hearing must be made in writing and filed with the Park-, & Open Space Division Director ("the Division Director") <br />within 48 hOUrs (exclusive of weekends) of receipt of this Notice at the following address: 1820 Rooqevelt, Blvd., Eugene, OR <br />97402. <br />The DI v I's ion Director shal schedule a time and place for the Intl arnial hearing to be conducted, which shal be riot more 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 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 infomial 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 ofthis Notice at the date and time shown above by: <br />- 17) <br />------- - - ------------- <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />6A� <br />(Signature of person being issued the notice) <br />While Copy, Public Works Green Copy file Yellow copy Report COPY Pink Copy Reelpient Gold Copy Offficer Appeal notice Rev- 04'03 <br />Name: Last F irst t dle <br />a t le <br />D013: <br />Race/ Scx� <br />Res. Address: s State <br />Zip <br />Res. Phone: <br />Work Phone: <br />Under the authority ofAdniinistrative 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 park& open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on5--31 J--I--,you violated Sectionj f the Park <br />and Open Space Rules, and/or Section 41 of the Eugene Code., 1971. and/or ORS To wit, you: <br />-0,,PctA W-TOM4/L JJ K I Lj� PYM � k 7124 0 <br />t <br />(Description of the violation.) <br />This restriction of use is effective heginning on and shall remain in effect untilS3)—/-s <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 info cal hearing to contest this Notice. A request for an <br />informal hearing must be made in writing and filed with the Park-, & Open Space Division Director ("the Division Director") <br />within 48 hOUrs (exclusive of weekends) of receipt of this Notice at the following address: 1820 Rooqevelt, Blvd., Eugene, OR <br />97402. <br />The DI v I's ion Director shal schedule a time and place for the Intl arnial hearing to be conducted, which shal be riot more 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 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 infomial 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 ofthis Notice at the date and time shown above by: <br />- 17) <br />------- - - ------------- <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />6A� <br />(Signature of person being issued the notice) <br />While Copy, Public Works Green Copy file Yellow copy Report COPY Pink Copy Reelpient Gold Copy Offficer Appeal notice Rev- 04'03 <br />