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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATF. TIME. -�qv CASE ft: q- 15il� <br />. ............. ........ ---­---­-­­-­'­ <br />LOCATION tPARKJe0FT,,N SPACE): JZ I 0651- 0 J� <br />XAi <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 />0 <br />(Description of the violation,) <br />4 <br />This restriction of use is effective beginning on _,and shall 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 crit 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 an <br />infonrial 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) ofreccipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the inforriml hearing to be condUCI.C(I, which shall be not inore 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 yen, 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 testirfrony, fi the infortnal 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 Notj�,,,pe at/X11" ate and tirne shown above by: <br />(Sionature of person issuing/delivering notice) <br />L- <br />I hereby acknowledge receipt of'the above Notice on the date and thne indicated above. <br />cxf <br />(Signature of person being issued the nodee) <br />Wl Copv= Pub] ic W,,j ks (91corl ( op� file Y dlow ('copy; kxpml Copy Pink ( ojpy. Rccpent (kqd 4 `stay: Offli cor Appeni notwe Rev 04 103 <br />Naraie Lag F irst Middle <br />D013 <br />Race/se <br />Ski f -r <br />(A, <br />I Res. Address: city <br />State Zip <br />Re's. Phone: <br />Work Plione� <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 />0 <br />(Description of the violation,) <br />4 <br />This restriction of use is effective beginning on _,and shall 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 crit 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 an <br />infonrial 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) ofreccipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the inforriml hearing to be condUCI.C(I, which shall be not inore 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 yen, 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 testirfrony, fi the infortnal 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 Notj�,,,pe at/X11" ate and tirne shown above by: <br />(Sionature of person issuing/delivering notice) <br />L- <br />I hereby acknowledge receipt of'the above Notice on the date and thne indicated above. <br />cxf <br />(Signature of person being issued the nodee) <br />Wl Copv= Pub] ic W,,j ks (91corl ( op� file Y dlow ('copy; kxpml Copy Pink ( ojpy. Rccpent (kqd 4 `stay: Offli cor Appeni notwe Rev 04 103 <br />