7.21.14 Park Restrictions - Laserfiche WebLink

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�. Name: Last First Middle DOB: Race."Sex: r— R - j j - 5 Res. Address: City.. State E:: Res, Phonc: Wmk Phone: T—W Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3 you are hereby notified that you are prohibited from (check box)- Entering in or using all City of Eugene parks, open spaces or facilities. W, The basis frt• this Notice of Restriction of Use is that on you violated Section f the Park and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: HINZOO)" " (Description of the violation.) This restriction of use is effective beginning on jhq—lq—1 and shall remain in effect untilVq4__- 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 arrested and charged with criminal trespass in the second degree. Pursuant top k and Open Space Mute R - you are entitled to an informal hearing to contest t h i s Notice. A request for an informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") within 49 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR 97402. The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be riot more than 72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the incident. The Div i sion Director may exc lude anyone, other than you and those presenting testimony, frorn the in formal heari ng This Notice shall remain In effect pending any requested hearing, This Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by re pers (S gnatu a� ties) I hereby acknowledge receipt of the above Notice on the date and time indicated above. - --- - - - - -- - ( Signature of person being issued the notice) 'Whi r- Copy: Public Works Grucii Copy Filc Y C upy: Report Copy Pink Copy: Rucipwnt Gold C"py Officm AppoM nudcc Rev, 04110,;