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NOTICE OF RESTRICTION OFUSE <br />and Notice of Right to Appeal <br />DATE: --y-29 I f <br />TIME: WXP" <br />0� <br />CASE #: N - <br />-------- - ----- <br />LOCATION (PARK/OPEN <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 />Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on you violated Section - LO <br />j the Park <br />and Open Space Rides, and/or Section of the Eugene Code, 1c171, and/or ORS To wit, you:� <br />(Description of the violation.) <br />This restriction of use is effective beginning on 02 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 pcii.od 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 It -1.074 you are entitled to an informal hearing to contest thi N otice . A reclucst 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 (exclusive (-)C weekends) of receipt of the rLquest 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 witn esses 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 tinie shown above by: <br />- ---------- - - - - - ---------------- - - - - - - - - <br />fignat of person isquinDidelivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicate 01 <br />---------- (SignatUre cal person being issued the nwice) <br />W h i k. C o py: Pul fl i c Wc rk q Grcrmcupy� 1`dc Yellow Copy: R elsort C opy Pink (- upy: R �O p i e nt Go ld C opy: 0 fri cer Appca I non" Rev, 04,103 <br />Name. Last First Middle <br />DOB: <br />Race, <br />Lj <br />Re Address: city <br />Store <br />Zip <br />Res. 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), 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 />X <br />The basis for this Notice of Restriction of Use is that on you violated Section - LO <br />j the Park <br />and Open Space Rides, and/or Section of the Eugene Code, 1c171, and/or ORS To wit, you:� <br />(Description of the violation.) <br />This restriction of use is effective beginning on 02 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 pcii.od 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 It -1.074 you are entitled to an informal hearing to contest thi N otice . A reclucst 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 (exclusive (-)C weekends) of receipt of the rLquest 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 witn esses 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 tinie shown above by: <br />- ---------- - - - - - ---------------- - - - - - - - - <br />fignat of person isquinDidelivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicate 01 <br />---------- (SignatUre cal person being issued the nwice) <br />W h i k. C o py: Pul fl i c Wc rk q Grcrmcupy� 1`dc Yellow Copy: R elsort C opy Pink (- upy: R �O p i e nt Go ld C opy: 0 fri cer Appca I non" Rev, 04,103 <br />