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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE; � C 114 TIME, J,� CASE <br />b� � ml Vioc) <br />LOCATION (PARK/OPl- S PACE) <br />Under the authority of; d inistr ative 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 />Y I Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis For this Notice of Restriction of Use is that on you violated Section <br />3 0 of the Park <br />and Open Space Rules, and/or Section! -)- `CO wit , y ou: AMA-6 <br />q_ of the Eugene Code, 1971, andlor ORS <br />PE f�X <br />Z <br />(Description ofthe violation-) <br />This restriction of use is effective beginning on b 1h Lk and shall remain in effect until <br />A <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you Irlay 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 fior an <br />infori hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />Z-- <br />within 48 hours (exclusive of weckcrids) ofreccipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule as time and place for the in6ormal hearing to be conducted, which shall be not more than <br />72 hours (exclusive ol'weekends) ofreceipt ofthe request for hearing. At the informal hearing the Division Director will only <br />consider testa - norry 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 testunony, from the informal 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 iii shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the dalle and time indicated above, <br />(Signature orperson being issued the notice) <br />While Cop Publi, Woiks Green ( opy File Yellow Copy: Repol'i Copy NA ( op y: R"ipieia Gold f opy� Ofifjc(n Appe;iA iofi�:C R l, 011iul <br />Narue� Last First Middle <br />D07 <br />Race/sex. <br />LC &,sto Kj rYA7CA 1 11�71 <br />Res, Ackiress: City <br />State <br />Zip <br />Res, Phone: <br />Work Phone: <br />Under the authority of; d inistr ative 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 />Y I Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis For this Notice of Restriction of Use is that on you violated Section <br />3 0 of the Park <br />and Open Space Rules, and/or Section! -)- `CO wit , y ou: AMA-6 <br />q_ of the Eugene Code, 1971, andlor ORS <br />PE f�X <br />Z <br />(Description ofthe violation-) <br />This restriction of use is effective beginning on b 1h Lk and shall remain in effect until <br />A <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you Irlay 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 fior an <br />infori hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />Z-- <br />within 48 hours (exclusive of weckcrids) ofreccipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule as time and place for the in6ormal hearing to be conducted, which shall be not more than <br />72 hours (exclusive ol'weekends) ofreceipt ofthe request for hearing. At the informal hearing the Division Director will only <br />consider testa - norry 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 testunony, from the informal 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 iii shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the dalle and time indicated above, <br />(Signature orperson being issued the notice) <br />While Cop Publi, Woiks Green ( opy File Yellow Copy: Repol'i Copy NA ( op y: R"ipieia Gold f opy� Ofifjc(n Appe;iA iofi�:C R l, 011iul <br />