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� <br />NOTICE OF RESTRICTION OF USE <br />and N ofice o Right to Appeal <br />DATE: TIME: CASE <br />LOCATION 1PARK/01 SPACE): N4 N <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis ror this Notice of Restriction of Use is that on you violated Section of the.Park- <br />and Open Space Rules, and/or Section 4AW­ of the Eugene Code, 1971, and/or ORS _, To wit, you:_ <br />0 A PAR-K jl­J 1-t I 0!�- HAV i N 6 <br />�V M I ML F VALI D P K 1Z JV S I CV W <br />the violation,) <br />This restriction of use is effective beginning on I and shall remain in effect until <br />II 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. Arequest roran <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 of weekends) of receipt of the request for hearing. At the info al hearing the Division Director will only <br />consider testimony fronts 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 these presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion ww; delivered to the person named at the top of this Notice at the date and time shown above by: <br />r <br />- - - - - -- <br />(Signature ot'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 I Pub Work 9 CjrucnCupy Fd Yellow CkTy: Report Copy Pink Copyc Rec'p ent Gold Copy Of Appeal notice R -,, . 04/ 3 <br />Name: Last First Middle <br />DMIV r 5 - R - I C - <br />-B <br />Race /S <br />Res. Address City <br />5ta zip I - <br />[ <br />Res. Phone.,- <br />ork Ph <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis ror this Notice of Restriction of Use is that on you violated Section of the.Park- <br />and Open Space Rules, and/or Section 4AW­ of the Eugene Code, 1971, and/or ORS _, To wit, you:_ <br />0 A PAR-K jl­J 1-t I 0!�- HAV i N 6 <br />�V M I ML F VALI D P K 1Z JV S I CV W <br />the violation,) <br />This restriction of use is effective beginning on I and shall remain in effect until <br />II 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. Arequest roran <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 of weekends) of receipt of the request for hearing. At the info al hearing the Division Director will only <br />consider testimony fronts 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 these presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion ww; delivered to the person named at the top of this Notice at the date and time shown above by: <br />r <br />- - - - - -- <br />(Signature ot'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 I Pub Work 9 CjrucnCupy Fd Yellow CkTy: Report Copy Pink Copyc Rec'p ent Gold Copy Of Appeal notice R -,, . 04/ 3 <br />