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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />�131��ow <br />DATE- d-- 'o— /� e TIME: CASE #: <br />LOCATION WARK/OPEN SPACE) r J�, 7V4 : <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 faciliti <br />X <br />The basis for this Notice of'RestEiction of Use is that on you violated Section/,A7 of the Park <br />and Open Space Rules, and/or Section / 57 of the Eugene Code, 1971, and/or OR S — ---------- — 1 'To wit, you: <br />(Description o the violation.) <br />This restriction of use is effective beginning on 6" and shall remain in effect until <br />If you enter in or use any City of Eugene park, opeii 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 R4,074 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 ("the Division Director") <br />within 4 hours (exclusive of weekends) o f receipt o thi Notice at the followin address: 1820 Roosevelt, Blvd, E ugene, OR <br />97402. <br />The Division Director shal sched u le a tirne and p ace for the I n ron hearing to be conducted, rh ich shal be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Dircctc)r will only <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />inc ident. The Division Director may exclude anyone, other than you and those presenting testimony, From the into xal 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 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- --------- <br />(Signature of person being issued the notice) <br />White Copy: Public Works Cawn Copy File Yellow Copy! Reporl Copy Pink Copv: Rmpient Gold Cc p y; 0 ffi cer Appea I notice Rev, 04? 03 <br />Name: Last First Middle <br />DOB: <br />RacefSex: <br />7111 <br />2 z1 -f d <br />t 1v7 <br />Res. Address; City <br />Res. Phone: <br />Work- Phoiw: <br />9-"- - <br />EL� <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 faciliti <br />X <br />The basis for this Notice of'RestEiction of Use is that on you violated Section/,A7 of the Park <br />and Open Space Rules, and/or Section / 57 of the Eugene Code, 1971, and/or OR S — ---------- — 1 'To wit, you: <br />(Description o the violation.) <br />This restriction of use is effective beginning on 6" and shall remain in effect until <br />If you enter in or use any City of Eugene park, opeii 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 R4,074 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 ("the Division Director") <br />within 4 hours (exclusive of weekends) o f receipt o thi Notice at the followin address: 1820 Roosevelt, Blvd, E ugene, OR <br />97402. <br />The Division Director shal sched u le a tirne and p ace for the I n ron hearing to be conducted, rh ich shal be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Dircctc)r will only <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />inc ident. The Division Director may exclude anyone, other than you and those presenting testimony, From the into xal 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 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- --------- <br />(Signature of person being issued the notice) <br />White Copy: Public Works Cawn Copy File Yellow Copy! Reporl Copy Pink Copv: Rmpient Gold Cc p y; 0 ffi cer Appea I notice Rev, 04? 03 <br />