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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: co c TIME: CASE #: <br />E): 0)(Fk( &(O(ko� <br />LO CATION (PARK/OPEN SPAC ......... ST — — - - ----- <br />M <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.00(3), you are herettv <br />notified that you are prohibited from (check box): <br />/RD Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) TJ <br />This restriction of use is effective beginning on G(--,I 6 1 4 , and shall remain in effect until 0 9 1 1 2 <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 Ft- 1. 074 you are enti ti to an informal 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 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 (exc [us i ve of weekends) of receipt of the request Ibr hearing, A t the informal hearing the Division Director will racily <br />consider testimony from you, City personnel involved in the incident that TOSU)1Cd in this Notice, and other witnesses to thL <br />incident. The Division Director nray exclude anyone, other than you and those presenting Ic%timony, from tile informal hearing, <br />This Notice shall reffnain in effect pending any requested hearing. <br />This Notice o Exclusion was delivered to the person narried at the top o C thi Nod cc at the date and time shown above by: <br />117 q — <br />-- f` <br />(Signature of person issuing/ d e i Ver Ig 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 />Whit Copy Pub I i c Workg GTec" Copy, Fie Y'dow Copy Report Copy Pink Copy: Recipient G,)W Copy, Appeal nolivu Rcv, 041913 <br />Name la First Middle <br />DOB: <br />+6 0 <br />Race`Qex: <br />Res. Address City <br />---------- <br />Est <br />Zip <br />Res. Phone: <br />Work Plione� <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.00(3), you are herettv <br />notified that you are prohibited from (check box): <br />/RD Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) TJ <br />This restriction of use is effective beginning on G(--,I 6 1 4 , and shall remain in effect until 0 9 1 1 2 <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 Ft- 1. 074 you are enti ti to an informal 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 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 (exc [us i ve of weekends) of receipt of the request Ibr hearing, A t the informal hearing the Division Director will racily <br />consider testimony from you, City personnel involved in the incident that TOSU)1Cd in this Notice, and other witnesses to thL <br />incident. The Division Director nray exclude anyone, other than you and those presenting Ic%timony, from tile informal hearing, <br />This Notice shall reffnain in effect pending any requested hearing. <br />This Notice o Exclusion was delivered to the person narried at the top o C thi Nod cc at the date and time shown above by: <br />117 q — <br />-- f` <br />(Signature of person issuing/ d e i Ver Ig 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 />Whit Copy Pub I i c Workg GTec" Copy, Fie Y'dow Copy Report Copy Pink Copy: Recipient G,)W Copy, Appeal nolivu Rcv, 041913 <br />