NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 0_74�tlil_ TIME: CASE <br />LOCATION (PAMC/OPE�N MIME): <br />�I IM D <br />� &V i t <br />Under the authorit of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />Y <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 for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section 4.190 of the Eugene Code, 1971, and/orORS_ To wit, you:- <br />f"c 6COS-5 j67 0 Ir- 8(AA <br />P- - <br />(Description of the violation.) <br />This restriction of use is effective beginning on 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 of thiLq 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. A request For an <br />informal hearing must be trade in writing and filed with the parks & Open Space Division Director ("the Division Director") <br />within d hours (exclusive of weekends) of receipt of this Notice at the fo address: 1820 Roosevelt, Blvd., E ugene, 0 R <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, ftorn the informal hearing. <br />This Notice shrill remain in effect pending any requested hearing. <br />This Notice (if 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/defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />6 61 Oqrg <br />(Signature of person being issued the notice) <br />What/ Copy, Public Works Oteen copy File Yellow Copy: Repml Copy Pink Copy, Recipicni Gold Co y; Offs yea" Appe, nuficz Rev ,04!03 <br />Name: Last F i rs I Middle <br />DOB: <br />Race/Sev <br />0SOiQ1 <br />6 F <br />Res, Address: City <br />Et <br />Zip <br />Res. Phone: <br />Work Phon e: <br />Under the authorit of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />Y <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 for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section 4.190 of the Eugene Code, 1971, and/orORS_ To wit, you:- <br />f"c 6COS-5 j67 0 Ir- 8(AA <br />P- - <br />(Description of the violation.) <br />This restriction of use is effective beginning on 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 of thiLq 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. A request For an <br />informal hearing must be trade in writing and filed with the parks & Open Space Division Director ("the Division Director") <br />within d hours (exclusive of weekends) of receipt of this Notice at the fo address: 1820 Roosevelt, Blvd., E ugene, 0 R <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, ftorn the informal hearing. <br />This Notice shrill remain in effect pending any requested hearing. <br />This Notice (if 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/defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />6 61 Oqrg <br />(Signature of person being issued the notice) <br />What/ Copy, Public Works Oteen copy File Yellow Copy: Repml Copy Pink Copy, Recipicni Gold Co y; Offs yea" Appe, nuficz Rev ,04!03 <br />