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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: T1 M E: <br />LOCATION (PARK/OPEN SPACF)-_ _ .. �_,q 70 <br />( <br />as <br />a <br />,j / z g5l <br />and Open Space Rules, and/or Section of the E ugene Code, 197 1, and/or ORS To wit, you <br />(Description of the violation.) <br />This restriction of use is effective beginning on (X 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 o 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 info al 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 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 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 infra nna I 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 Notic the date a e shown above by: <br />(Signature ofperqon isominghlehvefinu to Le) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the iioticc) <br />'White Copy� Public W(As (3recl5 Copy� File Yellow Cary Rupo rL Copy Teink Copy: R cc i p ient Gold Copy Officcr Appal noocc Rev OV03 <br />Nani Last First Middle <br />DOB: <br />1t -s <br />CatAS <br />06 1& A), <br />Res. Addreqs: City <br />Res. Phone: <br />Work Phone <br />and Open Space Rules, and/or Section of the E ugene Code, 197 1, and/or ORS To wit, you <br />(Description of the violation.) <br />This restriction of use is effective beginning on (X 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 o 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 info al 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 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 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 infra nna I 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 Notic the date a e shown above by: <br />(Signature ofperqon isominghlehvefinu to Le) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the iioticc) <br />'White Copy� Public W(As (3recl5 Copy� File Yellow Cary Rupo rL Copy Teink Copy: R cc i p ient Gold Copy Officcr Appal noocc Rev OV03 <br />