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ool <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE# <br />Ncb k <br />LOCATION (PARKIOPEN SPACE): V&2 j?d(C <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 frorn (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />The basis for this Notice of Restriction of Use is that on C <br />you violated Section <br />1-41417 the Park <br />and Open Space Rules, and/or Section TTI—Aoof the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on n6c(AN� and shall remain in effect until 0 1 � <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 iri the second degree, <br />Pursuant to Park and Open Space Rule R- I .07 4 you are entitled to an informal hearing to contest this Notice, A requess. fior an <br />informal hearing must be made in writing and filed with the Park% & Open Space Division Director ("the Division Director") <br />within 49 hours (exclusive o F weekends) o f receipt of this Notice at the following 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 more than <br />72 hours (exclusive of weekends) of receipt of the request ror hearing. At the int'Onnal 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 informal hearing. <br />T his 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 ti shown above by. <br />— 0 N-JoN(3-il --- It---- <br />(Signature of'person i notice) <br />I hereby acknowledge receipt of the above Notice on the date and time: indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Greencopy File Ye umv C%ly Repon Corw Pink Copy Rccipiew Gold Copy: 0-Fri ocr Appeal not i uc Rcv, OV103 <br />Nanie: Last First Nfidcilc <br />DOB: <br />Racv/Sex: <br />Res. Address: City <br />Statc <br />Zip <br />R.,,. Phone: <br />Work Phone: <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 frorn (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />The basis for this Notice of Restriction of Use is that on C <br />you violated Section <br />1-41417 the Park <br />and Open Space Rules, and/or Section TTI—Aoof the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on n6c(AN� and shall remain in effect until 0 1 � <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 iri the second degree, <br />Pursuant to Park and Open Space Rule R- I .07 4 you are entitled to an informal hearing to contest this Notice, A requess. fior an <br />informal hearing must be made in writing and filed with the Park% & Open Space Division Director ("the Division Director") <br />within 49 hours (exclusive o F weekends) o f receipt of this Notice at the following 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 more than <br />72 hours (exclusive of weekends) of receipt of the request ror hearing. At the int'Onnal 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 informal hearing. <br />T his 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 ti shown above by. <br />— 0 N-JoN(3-il --- It---- <br />(Signature of'person i notice) <br />I hereby acknowledge receipt of the above Notice on the date and time: indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Greencopy File Ye umv C%ly Repon Corw Pink Copy Rccipiew Gold Copy: 0-Fri ocr Appeal not i uc Rcv, OV103 <br />