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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to A ppea l <br />DATE: TIME: CASE <br />LOCATION (PARK/OPEN SPACE) <br />C 4. k <br />t � k � t v\leo <br />3 <br />i3 <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 />W Entering in or using all City of Eugene parks, open spaces or facilities. <br />7111 <br />The basis for this Notice of Restriction of Use is that on _Lh — I -Y, you violated Section L. C-APLI-q) the Park <br />and Open Space Rules, and/or Section of th Eugene Code, 1971 and/or OR To wit, you: <br />hCM -- - -------- <br />(Description of the violation,) <br />This restriction of use is effective beginning on - 1 �5j and s hall 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 this Notice, you may be <br />arrested and charged with criminal trespass in the siccond degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal bearing to contest this Notice A request for - <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 receiDt of this Notice at the followine address: 1820 Roosevelt. Blvd.. Ruvene. 01 <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the, informal hearing [he Division Director will ow <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident, The Division Director may exclude anyone, other than you and those presenting testiniony, from the informal hum iln <br />This Notice shall remAin in effect pLnding any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this No tice at th 42 t o and time shown above by: <br />- fit, tj< <br />— ----- ------------------ <br />(Signature ofper iS'Wing/dOlivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tinic indicated above, <br />( Sign hue of person being issued the notice) <br />White Copy: Public Works Green Copy: File YcHow Copyi Ruport Cop) Pink Copy: Recipient Cold Copy: Officer Appeal notice Rev- 04,03 <br />Name: Last First itidle <br />DOB: <br />R I S <br />a. <br />A561- <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <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 />W Entering in or using all City of Eugene parks, open spaces or facilities. <br />7111 <br />The basis for this Notice of Restriction of Use is that on _Lh — I -Y, you violated Section L. C-APLI-q) the Park <br />and Open Space Rules, and/or Section of th Eugene Code, 1971 and/or OR To wit, you: <br />hCM -- - -------- <br />(Description of the violation,) <br />This restriction of use is effective beginning on - 1 �5j and s hall 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 this Notice, you may be <br />arrested and charged with criminal trespass in the siccond degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal bearing to contest this Notice A request for - <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 receiDt of this Notice at the followine address: 1820 Roosevelt. Blvd.. Ruvene. 01 <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the, informal hearing [he Division Director will ow <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident, The Division Director may exclude anyone, other than you and those presenting testiniony, from the informal hum iln <br />This Notice shall remAin in effect pLnding any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this No tice at th 42 t o and time shown above by: <br />- fit, tj< <br />— ----- ------------------ <br />(Signature ofper iS'Wing/dOlivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tinic indicated above, <br />( Sign hue of person being issued the notice) <br />White Copy: Public Works Green Copy: File YcHow Copyi Ruport Cop) Pink Copy: Recipient Cold Copy: Officer Appeal notice Rev- 04,03 <br />