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NOTICE Of'RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME. -- Z�;2-/ a CASE # <br />LOCATION (PARKJOPEN SPACE): <br />I <br />LA <br />Under the authority of Administrative Order No. 5A-03-24-F and ?ark and Open Space R R-1.005(3), you are hereby <br />notifted that you are prohibited from (check box); <br />9 - Entering in or usiug all City of Eugene parks, open spaces or facilities- <br />N <br />The basis for this Notice of Restriction of Use is that on--6�-,7��, you violated Section of the Park <br />and Open Space Ru . 1es, an&or Section of the Eugene Code, 1971. and/or ORS To wit, you: <br />Z <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on-ff and shall remain in effect until — 61a2a- <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 second degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to air info al hearing to contest this Notice, Areq nest fear all <br />info rmal hearing must be made in writing and filed with the Parks & Open Space Division Director ( " <br />' "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 />consider testimony trom you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclud e a nyone, other than you and those presentin g testimony . from the informal hearing, <br />This Notice shall remain in erfect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this No tic c:,o4he (late and tirne shown above - by: <br />orperson Issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time; ind <br />(Signature of person being issued the notice) <br />White Copy Puhh,; Works Ureen Copy: File Ycllow Copy. Report Copy Pink Copy , RcJpwnt Gold Copy• Officev A ppca notice Roy, 041t03 <br />llawf: Las( Firqt Middle <br />D( <br />Res. Address: City <br />State <br />Zip <br />Res- Phone: <br />Work vllo le: <br />Under the authority of Administrative Order No. 5A-03-24-F and ?ark and Open Space R R-1.005(3), you are hereby <br />notifted that you are prohibited from (check box); <br />9 - Entering in or usiug all City of Eugene parks, open spaces or facilities- <br />N <br />The basis for this Notice of Restriction of Use is that on--6�-,7��, you violated Section of the Park <br />and Open Space Ru . 1es, an&or Section of the Eugene Code, 1971. and/or ORS To wit, you: <br />Z <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on-ff and shall remain in effect until — 61a2a- <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 second degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to air info al hearing to contest this Notice, Areq nest fear all <br />info rmal hearing must be made in writing and filed with the Parks & Open Space Division Director ( " <br />' "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 />consider testimony trom you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclud e a nyone, other than you and those presentin g testimony . from the informal hearing, <br />This Notice shall remain in erfect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this No tic c:,o4he (late and tirne shown above - by: <br />orperson Issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time; ind <br />(Signature of person being issued the notice) <br />White Copy Puhh,; Works Ureen Copy: File Ycllow Copy. Report Copy Pink Copy , RcJpwnt Gold Copy• Officev A ppca notice Roy, 041t03 <br />