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<br />NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />DATE,
<br />_0"1 _20V TIME� CASE #: 1 � - cH SZ.
<br />LOCATION (PARICIOPEN SPACE):__A��r eqgg, _&A
<br />Under the authorityof Administrative Order No. 58-03-24-F and Parkand Open SpaceRule R-1.005(3),you arehereby
<br />notified that you are prohibited from (check box):
<br />F Entering in or using all City of Eugene parks, open spaces or ficilitles.
<br />The basis for this Notice of Restriction of Use is that on you violated Section -0io I of the Park
<br />and Open Space Rules, and/or Section _f, 2,YD of the Eugene Code, 1971, and/or ORS -, To wit, you-,
<br />IAI /b. -ZJ4 ac' X - 0 - 2 - MAA",W tJf4i, - -V1Via k4Aie, 14A4JJ44& ist FVEr41AZK
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on ALa- -, and 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 />attested ftested and charged with criminal trespass in the second degree.
<br />Pursuant to Park and Open Space Rule 1t-1.074 you are entitled 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 ( 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 (exclusive of weekends) of receipt of the request for hearing, At the inforn 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 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 at the date , and time shown above by:
<br />(Signature of person issuin'g'delivc`rmg 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 worh 6reen Copy: He Yello% Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Apppat notice Rev. 04'03
<br />Name: Last First Middle
<br />DOB:
<br />Race/Sex:
<br />Sivoct
<br />D5 21
<br />Re
<br />Rey;. Address:
<br />State
<br />dip
<br />Res, Phone:
<br />Work Phone:
<br />- �NS Q S�
<br />Under the authorityof Administrative Order No. 58-03-24-F and Parkand Open SpaceRule R-1.005(3),you arehereby
<br />notified that you are prohibited from (check box):
<br />F Entering in or using all City of Eugene parks, open spaces or ficilitles.
<br />The basis for this Notice of Restriction of Use is that on you violated Section -0io I of the Park
<br />and Open Space Rules, and/or Section _f, 2,YD of the Eugene Code, 1971, and/or ORS -, To wit, you-,
<br />IAI /b. -ZJ4 ac' X - 0 - 2 - MAA",W tJf4i, - -V1Via k4Aie, 14A4JJ44& ist FVEr41AZK
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on ALa- -, and 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 />attested ftested and charged with criminal trespass in the second degree.
<br />Pursuant to Park and Open Space Rule 1t-1.074 you are entitled 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 ( 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 (exclusive of weekends) of receipt of the request for hearing, At the inforn 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 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 at the date , and time shown above by:
<br />(Signature of person issuin'g'delivc`rmg 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 worh 6reen Copy: He Yello% Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Apppat notice Rev. 04'03
<br />
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