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NOTICE OF RESTRICTION OF USE <br />DATE: 19 \ �� <br />and Notice of Right to Appeal <br />TIME: CASE# <br />b`As l5 eb,2- <br />LOCATION (PARKJOPEN SPACE): <br />C <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 />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 you violated Section Ga <br />� the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you:_ <br />N q e, <br />6�15-1r � �( ow�, <br />(Description cif the violation.) <br />This restriction of use is effective beginning on and shall remain in effect untd <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and Open Space Rule R -1.074 you are entitled to an informa I 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., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the inl'ori 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 from 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 informal hearing, <br />This Notice shall remain 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 />< 2 -:D <br />(Signature ofper%on issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />[Signature of ��er being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy! R"ipiunt Gold Copy: Officcr App al notice Rev, 041'tl3 <br />Mine: as irsd N-liddle <br />Aj <br />[)013: <br />Raceiscx: <br />vf j <br />Res. Addre � City — <br />State <br />Zip <br />Res.Phone� <br />Work P hone� <br />.......... �L2-a— _F <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 />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 you violated Section Ga <br />� the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you:_ <br />N q e, <br />6�15-1r � �( ow�, <br />(Description cif the violation.) <br />This restriction of use is effective beginning on and shall remain in effect untd <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and Open Space Rule R -1.074 you are entitled to an informa I 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., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the inl'ori 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 from 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 informal hearing, <br />This Notice shall remain 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 />< 2 -:D <br />(Signature ofper%on issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />[Signature of ��er being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy! R"ipiunt Gold Copy: Officcr App al notice Rev, 041'tl3 <br />