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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />(s) <br />DATE': TIME: /6 CASE # <br />LOCATION (PARK/OPEN SPACE): mLk <br />Under the authority of Administrative Order No. 58-03-24-F and Park amid Open Space Rule R-1,005(3), you are hereby <br />notified that van are prohibited frorn (check boy)-, <br />X Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 10CAQ /5 , and shall remain in effcct until <br />If you enter in or rise any City of Eugene park, open space or I "Acifity during the effective period of this Notice, you rnay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule It -1.074 you are entitled to an infonnal 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 of this Notice at the following address: 1820 Roosevelt, Blvd, Eug"ene, OR <br />97402. <br />The Division Director shall schedule a firric and place For the informal 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 informal hearing the Division Director will only <br />consider testimony fi you. City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident, The Division Director may eXCILide anyone, other than YOU an(] those presenting lestirriony. from the infion heaxing, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Excluslon was delivered to the person trained at the top of this Notice at the date and time shown above b7. <br />gg <br />(SignatUre of person issrnng.`defiverirtg notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of'person being issued the notice) <br />Whi�c- (op y: Puldic Woik GICO'nCopy: fi[e Ycilov Copy Repovi ( cyp� Pink Copy: Rcxipien3 Gold Cop . Officev App,!�d rumicc, ()-t O3 <br />i Name: Last First MicIdle <br />DOB <br />lzaceisex: <br />Address. CitV <br />S tate <br />Zip <br />Res, Mione <br />Wo r11- <br />Under the authority of Administrative Order No. 58-03-24-F and Park amid Open Space Rule R-1,005(3), you are hereby <br />notified that van are prohibited frorn (check boy)-, <br />X Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 10CAQ /5 , and shall remain in effcct until <br />If you enter in or rise any City of Eugene park, open space or I "Acifity during the effective period of this Notice, you rnay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule It -1.074 you are entitled to an infonnal 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 of this Notice at the following address: 1820 Roosevelt, Blvd, Eug"ene, OR <br />97402. <br />The Division Director shall schedule a firric and place For the informal 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 informal hearing the Division Director will only <br />consider testimony fi you. City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident, The Division Director may eXCILide anyone, other than YOU an(] those presenting lestirriony. from the infion heaxing, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Excluslon was delivered to the person trained at the top of this Notice at the date and time shown above b7. <br />gg <br />(SignatUre of person issrnng.`defiverirtg notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of'person being issued the notice) <br />Whi�c- (op y: Puldic Woik GICO'nCopy: fi[e Ycilov Copy Repovi ( cyp� Pink Copy: Rcxipien3 Gold Cop . Officev App,!�d rumicc, ()-t O3 <br />