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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />D ATE': <br />LOCATION (PARK/0PEN SPACE) <br />TIME: <br />CASE <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 />Lzntering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice oR <br />f'estrictio on <br />n of Use is that vou violated Section of the Park <br />and Open Space Rules, and/or Section ofthe Eugene Code, 197 1, and/or ORS Fo wit. you <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until ------ <br />KYOU enter in or use any City ofEugene park, open space or facility during the effective period ofthis Notice, you aria y be <br />arrested and charged with eni trespass in the second degree. <br />Pufsuant to Park and Open Space Rule R -1.074 you are entitled to an infornial hearing to contest this Notice, A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director <br />within 113 hours (CXCILISiVe of weekends) of receipt of this Notice at tire following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shal I schedule a tirnc and place flor the in hornial, hearing to be conducted, which shall be not niore than <br />72 hours (exclusive of weekend of receipt of the rectuest for hearing, At the int'ormal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, an(] other witnesses to the <br />incidellL The Division Director may exchide anyone, other than you and those presenting testirrioriv, fron the inkm 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 ofthis Notice al. the date and tines: shown above by: <br />(Signature of person issuing /delivering notice) <br />71 <br />I hereby acknowledge receipt offlic above Notice on the date and fine indicated above. <br />(Sn ature of person being issued the notice) <br />While ( op y. Wovks 61een ( opy ] Ydhm Oyp Rcjroll Copy Polk ( op y- Rxc tiers llS Oold Copy: Of is Apps i€ rmticc Rn 041:03, <br />Name,- Last First Middle <br />DOB: <br />Raec/Sex: <br />"S <br />Res. Addresq. City <br />Suite <br />Zip <br />Res, Plione <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 />Lzntering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice oR <br />f'estrictio on <br />n of Use is that vou violated Section of the Park <br />and Open Space Rules, and/or Section ofthe Eugene Code, 197 1, and/or ORS Fo wit. you <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until ------ <br />KYOU enter in or use any City ofEugene park, open space or facility during the effective period ofthis Notice, you aria y be <br />arrested and charged with eni trespass in the second degree. <br />Pufsuant to Park and Open Space Rule R -1.074 you are entitled to an infornial hearing to contest this Notice, A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director <br />within 113 hours (CXCILISiVe of weekends) of receipt of this Notice at tire following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shal I schedule a tirnc and place flor the in hornial, hearing to be conducted, which shall be not niore than <br />72 hours (exclusive of weekend of receipt of the rectuest for hearing, At the int'ormal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, an(] other witnesses to the <br />incidellL The Division Director may exchide anyone, other than you and those presenting testirrioriv, fron the inkm 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 ofthis Notice al. the date and tines: shown above by: <br />(Signature of person issuing /delivering notice) <br />71 <br />I hereby acknowledge receipt offlic above Notice on the date and fine indicated above. <br />(Sn ature of person being issued the notice) <br />While ( op y. Wovks 61een ( opy ] Ydhm Oyp Rcjroll Copy Polk ( op y- Rxc tiers llS Oold Copy: Of is Apps i€ rmticc Rn 041:03, <br />