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NOTICE OF RESTRICT ION OF USE
<br />and Notice offfight to Appeal
<br />TI M F: CA SE #
<br />DA
<br />LOCATION (PARK"'OPLN SPACF'
<br />...... — ------
<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 />notifl ed 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 vo u v i o lated Section
<br />100 i ) , )f the Park
<br />and Open Space Rules, and/or Section _ of the Eugene Code, 1971, and ?,"or OR - I I'll 1111-1----� TO wit, You
<br />P\,j coj
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on �(.)oo 6 , and shall remain in effect until
<br />If VOU enter in or rise any City of Eugene park, open space or facility during the effective period of this Notice, you may be
<br />arrested and charged with crit trespass in the second degree.
<br />Pursuant (o Park and Open Space Rule R -1.07> you are entitled to an informal hearing to contest this Notice, A request kw an
<br />informal hearing Must b ad
<br />Lie me in writing and filed with the Parks & Open Space Division Director ("the Division 13irlo
<br />ccr
<br />M
<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 time and place tbr the informal hearing to be conducted, which shall be not more 1h an
<br />72 hours (exclusive of weekends) cif receipt of the request for hearing.. t the inIca-inal hearing the Division Director will only
<br />consider testirnony front 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 testimony, from the ird "orn hearing
<br />This Notice shall rernain 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 time shown above by�
<br />(Signature ofpci i",uing"delivering no lice)
<br />I hereby acknowledge receipt ofthe above Notice on the (late and time indicated above.
<br />. ..... -------- -----
<br />(Signature ofperson being Issued the notice)
<br />While Cop : Public Woj Groerl (Ajpy HIC Yelhm (' opy: Repon Copy Pink Copy: Recipieni Gold Cop : ( - )ffircog Appc J rumee R 0-1 V,
<br />Name: Last FiTst Middle
<br />1 4 J A - 1j
<br />DOB:
<br />C N
<br />Racc/sex.,
<br />Res, Address: City
<br />slate
<br />Res, Phone:
<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 />notifl ed 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 vo u v i o lated Section
<br />100 i ) , )f the Park
<br />and Open Space Rules, and/or Section _ of the Eugene Code, 1971, and ?,"or OR - I I'll 1111-1----� TO wit, You
<br />P\,j coj
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on �(.)oo 6 , and shall remain in effect until
<br />If VOU enter in or rise any City of Eugene park, open space or facility during the effective period of this Notice, you may be
<br />arrested and charged with crit trespass in the second degree.
<br />Pursuant (o Park and Open Space Rule R -1.07> you are entitled to an informal hearing to contest this Notice, A request kw an
<br />informal hearing Must b ad
<br />Lie me in writing and filed with the Parks & Open Space Division Director ("the Division 13irlo
<br />ccr
<br />M
<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 time and place tbr the informal hearing to be conducted, which shall be not more 1h an
<br />72 hours (exclusive of weekends) cif receipt of the request for hearing.. t the inIca-inal hearing the Division Director will only
<br />consider testirnony front 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 testimony, from the ird "orn hearing
<br />This Notice shall rernain 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 time shown above by�
<br />(Signature ofpci i",uing"delivering no lice)
<br />I hereby acknowledge receipt ofthe above Notice on the (late and time indicated above.
<br />. ..... -------- -----
<br />(Signature ofperson being Issued the notice)
<br />While Cop : Public Woj Groerl (Ajpy HIC Yelhm (' opy: Repon Copy Pink Copy: Recipieni Gold Cop : ( - )ffircog Appc J rumee R 0-1 V,
<br />
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