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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 from (check box):
<br />Y 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 0C, I ?-, I -i you violated Section of the Park
<br />and Open Space Rules, and/or Section 4 tM of the Eugene Code, 1971, and/or ORS --. To wit, you
<br />-- Z-
<br />(Description of the violation-)
<br />This restriction of use is effective beginning on a LH, and shall remain in effect until C)q i t z - t
<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 informal hearing to contest this Notice. A request fir are
<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 jexclusiveofweekends�of
<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 />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 a e wn above by:
<br />Notice
<br />iganature of person issuing/delivering 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 Copy: File Yellow Copy: Report Copy Pint; Copy: Recipient Gold Copy: Officer Appeal norm e Rev. 04/03
<br />�,, 3 Ce 5 11
<br />Name: Last Fira Middle
<br />DOB:
<br />Racclse :
<br />Res. Address: City
<br />State
<br />FT
<br />Zip
<br />]p
<br />Res, Phone:
<br />Work Phone:
<br />,,s
<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 from (check box):
<br />Y 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 0C, I ?-, I -i you violated Section of the Park
<br />and Open Space Rules, and/or Section 4 tM of the Eugene Code, 1971, and/or ORS --. To wit, you
<br />-- Z-
<br />(Description of the violation-)
<br />This restriction of use is effective beginning on a LH, and shall remain in effect until C)q i t z - t
<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 informal hearing to contest this Notice. A request fir are
<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 jexclusiveofweekends�of
<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 />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 a e wn above by:
<br />Notice
<br />iganature of person issuing/delivering 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 Copy: File Yellow Copy: Report Copy Pint; Copy: Recipient Gold Copy: Officer Appeal norm e Rev. 04/03
<br />�,, 3 Ce 5 11
<br />
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