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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: C C 1 C 4 3 CASE 4! <br />LOCATION (PARKJOPEN SPACE):___JP3 PV611 <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3)4 you are hereby <br />notified that you are prohibited from (check box). <br />Ej Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restriction of Use is that on-D6 you. violated Section o(j_tLke Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, ancuor OR — - - . ...... To wit, you:__ <br />(Description o the violation.) <br />This restriction of use is effective heginning on and shall remain in effect until 7� <br />If you enter in or use any City of Eugene park, open space or facility during the efrective period of this Notice, you inay be <br />arrested and charged with criminal trespass in the second degree. <br />PUrSiLiant to Park and Open Space Rule R-1.074 yoii are entitled to an informal hearing to contest this Notice. A request for an <br />inforinal hearing must be inade in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of'weekends) of receipt offlusNotice at the following address: 1 2 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 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 y ou and those presenting testimony, from the info al heari ng, <br />This Notice shall remain in effect pending tiny requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and tirue shown above by <br />(Signature <br />'n i, <br />s, <br />o <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />�4 <br />(Signature of person being issued the <br />White Copy, Public Work, Grcen Copy: Filc Yel low Copy I Repon cepy P nk Copy: R � gn rvn t W d Copy Offi cer Appeal noi i cc <br />Flame: Last First Middle <br />D01i <br />Race"s <br />Res. Address City <br />........... <br />State <br />Zip <br />Re, Phone: <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3)4 you are hereby <br />notified that you are prohibited from (check box). <br />Ej Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restriction of Use is that on-D6 you. violated Section o(j_tLke Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, ancuor OR — - - . ...... To wit, you:__ <br />(Description o the violation.) <br />This restriction of use is effective heginning on and shall remain in effect until 7� <br />If you enter in or use any City of Eugene park, open space or facility during the efrective period of this Notice, you inay be <br />arrested and charged with criminal trespass in the second degree. <br />PUrSiLiant to Park and Open Space Rule R-1.074 yoii are entitled to an informal hearing to contest this Notice. A request for an <br />inforinal hearing must be inade in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of'weekends) of receipt offlusNotice at the following address: 1 2 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 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 y ou and those presenting testimony, from the info al heari ng, <br />This Notice shall remain in effect pending tiny requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and tirue shown above by <br />(Signature <br />'n i, <br />s, <br />o <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />�4 <br />(Signature of person being issued the <br />White Copy, Public Work, Grcen Copy: Filc Yel low Copy I Repon cepy P nk Copy: R � gn rvn t W d Copy Offi cer Appeal noi i cc <br />