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NOTICE OF RESTRICTION OF USE <br />and Noticeoflight to Appeal <br />DATE: TIME <br />LOCATION (PARK'OPEN SPACE): <br />CASE #. <br />q— I <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( 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 facilities. <br />a <br />(Description of the violation.) <br />This restriction of use is effective beginning on 6- a and shall rcrnain in effect until <br />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 <br />arrested and charged with criminal trespass in the %ccond degree. <br />Pursuant to Park and Open Space Rule -1.07 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 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 [car hearing. At the informal 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 informa I hearing. <br />This Notice shall re rnain 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 />11ilm If pello, I urg(d4i _V"1_ ng notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />(Signatare of person being issued the notice) <br />Whhe Copy; ftblio Works f3wenCopy: Fite Yellow Copy: Rep-oil. Copy Fink Copy_ R�, (joki Oupy ; O fficer Apptal mgicc Rev, 04/03 <br />Nan : asst fi rst Middle <br />DOB� <br />Race/Se <br />o exr t M,/) rjTE <br />R s. Add 2 s Citv <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />3 'e <br />H <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( 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 facilities. <br />a <br />(Description of the violation.) <br />This restriction of use is effective beginning on 6- a and shall rcrnain in effect until <br />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 <br />arrested and charged with criminal trespass in the %ccond degree. <br />Pursuant to Park and Open Space Rule -1.07 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 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 [car hearing. At the informal 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 informa I hearing. <br />This Notice shall re rnain 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 />11ilm If pello, I urg(d4i _V"1_ ng notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />(Signatare of person being issued the notice) <br />Whhe Copy; ftblio Works f3wenCopy: Fite Yellow Copy: Rep-oil. Copy Fink Copy_ R�, (joki Oupy ; O fficer Apptal mgicc Rev, 04/03 <br />