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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME, CASE #: 0 <br />LOCATION {PAM /OPEN SPACE); <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that yon are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or Facilities. <br />11 <br />The basis for this Notice of Restriction of Use is that on you violated Section T O,Q�jj of the Park <br />and Open Space Rules, and/or Section 0 of the Eugene Code, 1971„ and /or ORS To wit, you:_ <br />jr kt 0,� PeAd F!;.K L01- .0 ftL. CO A C- "V% V <br />(Description of the violation.) <br />This restriction of use is effective beginning on 1 11q and shall remain in effect it <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 hil'otirial 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 ofweekends) of receipt of this Notice at the following address: 1920 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the infon hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) o f receipt of the request for hearing. At the infra rtna I hearing the Division Director gil only <br />consider testimony from you, City personnel hivolved 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 infornual hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exc I usion was delivered to the person named at the top of this Nod ce at the date and time shown above by: <br />re <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />�s son being issued. the notice) <br />White Copy: Pub is Work Green Copy! File Ye flow Copy: Rupvrt Copy Pink Copy� Recipient Gold Copy: Officer Appeal nonce Rev- 04M <br />Name: Last First it <br />DOB: <br />Race./Sex: <br />P, <br />Res. Address City <br />State <br />Zip <br />Res. Phone: <br />Work Photic: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that yon are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or Facilities. <br />11 <br />The basis for this Notice of Restriction of Use is that on you violated Section T O,Q�jj of the Park <br />and Open Space Rules, and/or Section 0 of the Eugene Code, 1971„ and /or ORS To wit, you:_ <br />jr kt 0,� PeAd F!;.K L01- .0 ftL. CO A C- "V% V <br />(Description of the violation.) <br />This restriction of use is effective beginning on 1 11q and shall remain in effect it <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 hil'otirial 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 ofweekends) of receipt of this Notice at the following address: 1920 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the infon hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) o f receipt of the request for hearing. At the infra rtna I hearing the Division Director gil only <br />consider testimony from you, City personnel hivolved 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 infornual hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exc I usion was delivered to the person named at the top of this Nod ce at the date and time shown above by: <br />re <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />�s son being issued. the notice) <br />White Copy: Pub is Work Green Copy! File Ye flow Copy: Rupvrt Copy Pink Copy� Recipient Gold Copy: Officer Appeal nonce Rev- 04M <br />