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NOTICE OFR EST RICTION OFUSE <br />and Notice of [tight to Appeal <br />a <br />DATE: TIME: prh CASE A. <br />LOCA (PARKIOPEN SPACE):_--AV --------- Pftluc---- <br />Under the authority 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 this Notice of Restriction of Use is that on you violated Section QL, of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you:AC&IRIL <br />I � 7AX rVIA — ,%uftWP - 771i5l 1 <br />(Description of the violation.) <br />This restriction of use is effective beginning on S1 L l and shall remain in effect until h <br />I f you enter in or use any City o Eugene park, open space or facili during the effec fivc period or this N otice, you may be <br />arrested and charged with crii trespass in the second degree. <br />Pursuant to Park and Open Space Rule R - you are entitled to an infori hearing to contest this Notice. A request for an <br />informal hearing must be inade 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 mare than <br />72 hours (exclusive of weekends) of receipt of the request toy hearing. At the infOrmal hearing the Division Director will only <br />consider testimony fro m 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 informal hearing. <br />This Notice shall remdetin in effect per any requested hearing. <br />Thi Notice o r 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/ delivering 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 Cupy Public Work,s Green Copy! File YellA Copy: Repon Copy Pink C cry R"ipiunt G 6 d Copy 0 friocr Appeal not ix RVV- WMI <br />Narne: Last Firqt Middle <br />DOB: <br />Race/Sex: <br />=01 1AJ'5Jt T�'f 14 <br />Wo <br />kn <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone. <br />------ -- ---- ---- <br />1 <br />4 7 '1 - <br />Under the authority 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 this Notice of Restriction of Use is that on you violated Section QL, of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you:AC&IRIL <br />I � 7AX rVIA — ,%uftWP - 771i5l 1 <br />(Description of the violation.) <br />This restriction of use is effective beginning on S1 L l and shall remain in effect until h <br />I f you enter in or use any City o Eugene park, open space or facili during the effec fivc period or this N otice, you may be <br />arrested and charged with crii trespass in the second degree. <br />Pursuant to Park and Open Space Rule R - you are entitled to an infori hearing to contest this Notice. A request for an <br />informal hearing must be inade 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 mare than <br />72 hours (exclusive of weekends) of receipt of the request toy hearing. At the infOrmal hearing the Division Director will only <br />consider testimony fro m 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 informal hearing. <br />This Notice shall remdetin in effect per any requested hearing. <br />Thi Notice o r 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/ delivering 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 Cupy Public Work,s Green Copy! File YellA Copy: Repon Copy Pink C cry R"ipiunt G 6 d Copy 0 friocr Appeal not ix RVV- WMI <br />