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NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />I Tjw: CASE � ft
<br />DA j 5 / ��
<br />LOCATION (PARK/0PEN SPACE):
<br />\o��q
<br />i � -16�v�
<br />Under the authority of Administrative Order No. 58-03-24-F anti 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 />The basis for this Notice of Restriction of Use is that on 1 f , you violated Section of the Park
<br />and 0 en Space
<br />e Rules, nd/or Section �lr Qfthe Eu Cod
<br />gene e, 1971, and/or OR 1'o wit, You:
<br />P
<br />12c�>j
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on /0 'w"Afand 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 rnay be
<br />arrested and charged wi�h criminal trespass in the second degree.
<br />Pursuant to Park and Open Space Rule R- 1,1974 you are entitled to all informal hearing to contest this Notice, A request for an
<br />informal hearing must be made in writing and filed with the Par" & Open Space Division Director ("the Division Director")
<br />within 48 hours (exclusive of weekends) of receipt; of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, Oil
<br />97402.
<br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not knore than
<br />72 hours (exclrtsive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only
<br />consider testimony from YOU, City personnel involved in the incident that resulted irl this Notice., and other witnesses to the
<br />incident. The Division Director may exclude anyore, other YOU and those presenting testimony, fi the infiormal hearing,
<br />This Notice shall remain in effect pending any requested hearing.
<br />This Notice ol'Exclusion was delivered to the person named at the top ofthis Notice at tile date and firne shown above by:
<br />(Signature of person issuing/delivering riolice)
<br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated above-
<br />(Sign being -I ns — tile, 6
<br />, tore, j t)
<br />Whilo Copy: PuMc Work, Grcen Copy: 1-fle yellow Copy: kcpoll Copy Pink Copy: Re6picm GAI ( op}: Offlicer AppQui notice Rev- 04 `s3,
<br />Narne, Last First Middle
<br />DOB:
<br />0 "3 0
<br />Race/Scx-
<br />Res', address; Ci1v
<br />stau
<br />Zip
<br />Res- Phone
<br />Work Phone�
<br />Under the authority of Administrative Order No. 58-03-24-F anti 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 />The basis for this Notice of Restriction of Use is that on 1 f , you violated Section of the Park
<br />and 0 en Space
<br />e Rules, nd/or Section �lr Qfthe Eu Cod
<br />gene e, 1971, and/or OR 1'o wit, You:
<br />P
<br />12c�>j
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on /0 'w"Afand 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 rnay be
<br />arrested and charged wi�h criminal trespass in the second degree.
<br />Pursuant to Park and Open Space Rule R- 1,1974 you are entitled to all informal hearing to contest this Notice, A request for an
<br />informal hearing must be made in writing and filed with the Par" & Open Space Division Director ("the Division Director")
<br />within 48 hours (exclusive of weekends) of receipt; of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, Oil
<br />97402.
<br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not knore than
<br />72 hours (exclrtsive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only
<br />consider testimony from YOU, City personnel involved in the incident that resulted irl this Notice., and other witnesses to the
<br />incident. The Division Director may exclude anyore, other YOU and those presenting testimony, fi the infiormal hearing,
<br />This Notice shall remain in effect pending any requested hearing.
<br />This Notice ol'Exclusion was delivered to the person named at the top ofthis Notice at tile date and firne shown above by:
<br />(Signature of person issuing/delivering riolice)
<br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated above-
<br />(Sign being -I ns — tile, 6
<br />, tore, j t)
<br />Whilo Copy: PuMc Work, Grcen Copy: 1-fle yellow Copy: kcpoll Copy Pink Copy: Re6picm GAI ( op}: Offlicer AppQui notice Rev- 04 `s3,
<br />
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