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NOTICE OF RESTRICTION OF USE Id I) 1i <br />and Notice of Right to Appeal <br />DATE: <br />TIME: h3l <br />CASE 4! <br />S <br />LOCATION (PARK/0PEN PA(' ): <br />2 2 �-Aj� - - ------- I VA5 RY'N'L" <br />-Lvt <br />A I --------- --------- - ------------- ----- ------- <br />Under the authorit y of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R0 <br />-1.05( a <br />3), you re 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 />a <br />(Description of the violation,) <br />This restriction of use is effective beginning and shall remain in effect until lt <br />If you enter in or Use any City Of ELigene park, open space or facility during the effective period of dais Notice, you may be <br />arrested and charged with crinurial trespass in the second degree. <br />Pursuant to Nark and Open Space lZule R- 1,074 you are entitled to an informal hearing to contest this Notice. A request for an <br />infornial hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (cxclusivc ofweckends) of receipt ofthis Notice at the followingaddress: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shal schedule a time and place lor the infori hearing to be conducted, which shall be not mote thang <br />72 hours (exclusive of weekends) oftecelpt of the request for hearing. At the infornial hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to tile <br />incident. The Division Director may exclude anyone, other than you and those presenting testiniony, from the in f hearing. <br />'his Notice shall remain in effect pending any requested hearing. <br />This Notice ol'Exclusion was delivered to the person narned at the top of this Notice at the date and lime shown above by: <br />39 <br />(Signatrue of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tine indicated above, <br />(Signature of person being issued the notice) <br />Z-- 0 <br />whiw ( opy: Public Code Gn"Cll(op""': hic YeRow Copy: Report Copy Pink Copy: Recipwal Gold Copy: Orfio,n Appeal nolice R 0446 <br />Name: , LakL First Middle <br />DOB <br />S <br />Res. Addres- cit t <br />. .......... .. <br />State <br />Res, Phone: <br />Work Plione: <br />Under the authorit y of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R0 <br />-1.05( a <br />3), you re 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 />a <br />(Description of the violation,) <br />This restriction of use is effective beginning and shall remain in effect until lt <br />If you enter in or Use any City Of ELigene park, open space or facility during the effective period of dais Notice, you may be <br />arrested and charged with crinurial trespass in the second degree. <br />Pursuant to Nark and Open Space lZule R- 1,074 you are entitled to an informal hearing to contest this Notice. A request for an <br />infornial hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (cxclusivc ofweckends) of receipt ofthis Notice at the followingaddress: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shal schedule a time and place lor the infori hearing to be conducted, which shall be not mote thang <br />72 hours (exclusive of weekends) oftecelpt of the request for hearing. At the infornial hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to tile <br />incident. The Division Director may exclude anyone, other than you and those presenting testiniony, from the in f hearing. <br />'his Notice shall remain in effect pending any requested hearing. <br />This Notice ol'Exclusion was delivered to the person narned at the top of this Notice at the date and lime shown above by: <br />39 <br />(Signatrue of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tine indicated above, <br />(Signature of person being issued the notice) <br />Z-- 0 <br />whiw ( opy: Public Code Gn"Cll(op""': hic YeRow Copy: Report Copy Pink Copy: Recipwal Gold Copy: Orfio,n Appeal nolice R 0446 <br />