NOTICE OF RESTRiur[ON OF USE <br />and Notice of Right to Appeal <br />DA CAS E # <br />LOCATION (PARK/ SPACE): <br />0, <br />Under the authority ofAdministrative Order No. 58-03-24-F and Park and Open Space Rule 11-1.005(3), you kire hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all Cily of ugene parks, open spaces or facilities. <br />CK-1 <br />X <br />(Description ot violation.,) <br />'This restriction of use is effective beginning on and shall remain in effect until <br />11 Votj enter III or use any City of Fugene park, open spacc or facility 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 1�ule R-1,074 YOU are entitled to an uAlormal hearing to contest this Notice. A request for an <br />informal hearing niust be made in writing and filed with the Parks, & Open Space DiOslon Director ("the Division Director <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />9740L <br />The Division Director shall schedule as three and place for the informal hearing ter be coo ducted. which shall be not more than <br />T2 hours (exclusive of weekends) of receipt of the request for hearing. At the inbormal hearing the Dlvision Director will only <br />consider testimony from you, C.Ity personnel involved in the incident that I in this Notice, and other to the <br />incident, "Hic Division Director rnay exclude anyone, other than VOU and those presenting test inion y. 1 the inl'orrrial fwaj ing, <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 of this Notice <br />M <br />i nercoy acKnowicoge receipt of tric anove ,Notice on me (late ana ume 1n <br />L <br />dare and there shown above by: <br />of person issuing /delivering notice) <br />wlwc Copy 1 4k ol bs 0xu(op , I ily yak,w (opy. R,I)on Cop Pink Cup Recipicni Oukl Copy: Officer App-al no6cc R, -, CH 0 <br />Narn- Last F _rst iddle <br />EAM Avtfi <br />DOB: <br />Race/SC <br />Cilv stite Zap <br />Res- Phone: <br />Work fl, wne: <br />Under the authority ofAdministrative Order No. 58-03-24-F and Park and Open Space Rule 11-1.005(3), you kire hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all Cily of ugene parks, open spaces or facilities. <br />CK-1 <br />X <br />(Description ot violation.,) <br />'This restriction of use is effective beginning on and shall remain in effect until <br />11 Votj enter III or use any City of Fugene park, open spacc or facility 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 1�ule R-1,074 YOU are entitled to an uAlormal hearing to contest this Notice. A request for an <br />informal hearing niust be made in writing and filed with the Parks, & Open Space DiOslon Director ("the Division Director <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />9740L <br />The Division Director shall schedule as three and place for the informal hearing ter be coo ducted. which shall be not more than <br />T2 hours (exclusive of weekends) of receipt of the request for hearing. At the inbormal hearing the Dlvision Director will only <br />consider testimony from you, C.Ity personnel involved in the incident that I in this Notice, and other to the <br />incident, "Hic Division Director rnay exclude anyone, other than VOU and those presenting test inion y. 1 the inl'orrrial fwaj ing, <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 of this Notice <br />M <br />i nercoy acKnowicoge receipt of tric anove ,Notice on me (late ana ume 1n <br />L <br />dare and there shown above by: <br />of person issuing /delivering notice) <br />wlwc Copy 1 4k ol bs 0xu(op , I ily yak,w (opy. R,I)on Cop Pink Cup Recipicni Oukl Copy: Officer App-al no6cc R, -, CH 0 <br />