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NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />DATF: Cl /I oli TIME r CASFX #
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<br />M
<br />D ' \
<br />LOCATION (PARK/OPLN Sl"ACE): m , ? , v
<br />ftjt&_—Sh-� v — — ---------- - --- . ....
<br />Underthe authority of Administrative Order No. 58-03-24-F and Park and Open ace Bete R-1.005(3), you are hereby
<br />notified that you are prohibited from (check box):
<br />1 Entering in or using all City of Eugene parks, open spaces or facilities.
<br />X
<br />The basis for this Notice of'Restriction of Use is that on CA
<br />.. , " �i 4, i-1 - -- ----------- you violated Section, the Park
<br />and Open Space Rules, arid/or Section ofthe Eugene Code, 1971, andfor ORS To wit, Yok.l:
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on ( Ald 0A and shall rernain in effect until 1011011 .
<br />If you enter in or use any City of Eugene park, open space or facility during [tic el"I'ective period of this" Notice, YOU Inay be
<br />arrested and charged with criminal trespa e. ss in the second degre
<br />Z7
<br />Pursuant to Park and Open Space Rule R- 1 "074 You are entitled to an infortrial 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 48 hours (exclusive of weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR
<br />97402.
<br />The Division Director shall schedule a tinic arid place !'( the Hilbrinal hearing to be conducted, which shall be not more than
<br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infornial hearing the Division Director only
<br />consider testimony frOD1 YOU, City Personnel involved in the incident that resulted in this Notice, and other witnesses to [lie
<br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, frorrithe inforrmal hearing,
<br />This Notice shall remain in effect pending any requested hearing,
<br />'rnis Notice of Exclusion was delivered to the person named at the top ofthis Notice a/� arid time shown above by
<br />(Sionature of person issuin
<br />g/delivering notice)
<br />-401
<br />I herettv acknowledge receipt of the above Notice on [tie date arid tirne indicated abov
<br />-ec'.CL"� q -U ,
<br />(Signature of person being issued the notic ell
<br />winiti Copv: PuHic wwk"e (�Fcm 0,11Y Hh' Yellow Copy: Kcpon ( opy PinlG Coj Re�.jjmcrl Gold Coliv Offiicer Appeal noij, c Rc", - 0-U0.3
<br />Nai Last ina Middle
<br />DOB
<br />Race."Se
<br />Z- 1-3
<br />Res. Address: Oty Stale Zip
<br />Res, Phone:
<br />Work Phone:
<br />.... . .....
<br />- - ------------
<br />Underthe authority of Administrative Order No. 58-03-24-F and Park and Open ace Bete R-1.005(3), you are hereby
<br />notified that you are prohibited from (check box):
<br />1 Entering in or using all City of Eugene parks, open spaces or facilities.
<br />X
<br />The basis for this Notice of'Restriction of Use is that on CA
<br />.. , " �i 4, i-1 - -- ----------- you violated Section, the Park
<br />and Open Space Rules, arid/or Section ofthe Eugene Code, 1971, andfor ORS To wit, Yok.l:
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on ( Ald 0A and shall rernain in effect until 1011011 .
<br />If you enter in or use any City of Eugene park, open space or facility during [tic el"I'ective period of this" Notice, YOU Inay be
<br />arrested and charged with criminal trespa e. ss in the second degre
<br />Z7
<br />Pursuant to Park and Open Space Rule R- 1 "074 You are entitled to an infortrial 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 48 hours (exclusive of weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR
<br />97402.
<br />The Division Director shall schedule a tinic arid place !'( the Hilbrinal hearing to be conducted, which shall be not more than
<br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infornial hearing the Division Director only
<br />consider testimony frOD1 YOU, City Personnel involved in the incident that resulted in this Notice, and other witnesses to [lie
<br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, frorrithe inforrmal hearing,
<br />This Notice shall remain in effect pending any requested hearing,
<br />'rnis Notice of Exclusion was delivered to the person named at the top ofthis Notice a/� arid time shown above by
<br />(Sionature of person issuin
<br />g/delivering notice)
<br />-401
<br />I herettv acknowledge receipt of the above Notice on [tie date arid tirne indicated abov
<br />-ec'.CL"� q -U ,
<br />(Signature of person being issued the notic ell
<br />winiti Copv: PuHic wwk"e (�Fcm 0,11Y Hh' Yellow Copy: Kcpon ( opy PinlG Coj Re�.jjmcrl Gold Coliv Offiicer Appeal noij, c Rc", - 0-U0.3
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