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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: ( L— ) cl C4 <br />—,o­6A--"�k­­-- — --- - - - - -- <br />LOCATION (PARK/0PEN SPACE) <br />Under the authority of Administrative OrderNo. 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 parks, open spaces or facilities. <br />El <br />0 <br />The ba for this Notice of Restriction of Use is that on j you violated Section "k6 1 1 the park <br />tend Open Space Rules, and/or Section of the Eugene Code, 1971, and'or ORS­­ To wit, you <br />(Description of the violation.) <br />This restriction of use is effective beginning on 0 61 A Y, Land shall remain in effect until <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 infortual hearing to contest this Notice. Arequestforan <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 />974412. <br />I 11C Ul V 1 URI cs.�[kjl S[Idll slu - ule 7 alHu )141 I(A I I L I ly, 10 Liu Cul lum; Mfu MMC 111UH <br />7- hours (exclusive of weekends) of receipt of the, request for hearing. At the informal hearing the Divis ion Director wi H onh <br />consider testimony from you, City personnel involved in the, incident that resulted in this Notice, and other witnesses to the <br />iricldcnt The Div] sion Director may exclude anyon other than you and those presenting testimony, from the infornial 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 of this Notice at the date and th shown above by: <br />(Signature of person issuing/d °A ivering 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 Green Cnpv: File Yellow Copy: Report Copy Pink Copy Recipient Guld Ca py� Offico Appcal maicc Rev, G41103 <br />Nanie: Last First Middle <br />DOB� <br />Race,'Sex: <br />k , 0 L <br />("4j VV\ <br />cl� <br />Res, Address: City <br />State <br />I Zip <br />Res, Phone: <br />W k Ph nc- <br />' 9 6, 6 <br />Under the authority of Administrative OrderNo. 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 parks, open spaces or facilities. <br />El <br />0 <br />The ba for this Notice of Restriction of Use is that on j you violated Section "k6 1 1 the park <br />tend Open Space Rules, and/or Section of the Eugene Code, 1971, and'or ORS­­ To wit, you <br />(Description of the violation.) <br />This restriction of use is effective beginning on 0 61 A Y, Land shall remain in effect until <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 infortual hearing to contest this Notice. Arequestforan <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 />974412. <br />I 11C Ul V 1 URI cs.�[kjl S[Idll slu - ule 7 alHu )141 I(A I I L I ly, 10 Liu Cul lum; Mfu MMC 111UH <br />7- hours (exclusive of weekends) of receipt of the, request for hearing. At the informal hearing the Divis ion Director wi H onh <br />consider testimony from you, City personnel involved in the, incident that resulted in this Notice, and other witnesses to the <br />iricldcnt The Div] sion Director may exclude anyon other than you and those presenting testimony, from the infornial 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 of this Notice at the date and th shown above by: <br />(Signature of person issuing/d °A ivering 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 Green Cnpv: File Yellow Copy: Report Copy Pink Copy Recipient Guld Ca py� Offico Appcal maicc Rev, G41103 <br />