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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: - nME: CAS E #: <br />1.0✓ATION (PARS `OPEN SPACE): Aw"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 />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 th is Noti cc o f Res tri ct] on of Use is that ong'(3- f q you violated Section 11,16*crf the Park <br />and Open Space Rules, andJor Section =t q 0 <br />of the Eugene Code, 1971, and/or CARS To wit, you: <br />Mb ra- <br />1�j vjvqj� <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in e ffect until <br />If you enter in or use any City of Eugene park, open space or faci d uring the ef fective period of this N otice, you inay 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 Mi <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 weekend ofreceipt 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 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 info rnia 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 Notice at the date and time sdio -n above by: <br />s'no <br />(Signature of person issuinYgv/elivering 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! Public Wofks Green Co[w: File Ye I I ow C Report Copy Pink Copy! R� ipipnt GAI Copy: Offirur App", I notwe R4v_ 04,,03 <br />Name: Last First Mi dtc <br />7j 2� <br />D(r: <br />Res. Address: City <br />st; <br />...... . ............ <br />Res. Phc;y� <br />Work Phone� <br />Al( ^_ <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 />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 th is Noti cc o f Res tri ct] on of Use is that ong'(3- f q you violated Section 11,16*crf the Park <br />and Open Space Rules, andJor Section =t q 0 <br />of the Eugene Code, 1971, and/or CARS To wit, you: <br />Mb ra- <br />1�j vjvqj� <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in e ffect until <br />If you enter in or use any City of Eugene park, open space or faci d uring the ef fective period of this N otice, you inay 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 Mi <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 weekend ofreceipt 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 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 info rnia 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 Notice at the date and time sdio -n above by: <br />s'no <br />(Signature of person issuinYgv/elivering 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! Public Wofks Green Co[w: File Ye I I ow C Report Copy Pink Copy! R� ipipnt GAI Copy: Offirur App", I notwe R4v_ 04,,03 <br />