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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DA TIME: CASE # <br />LOCATION (PARK/OPEN SPACE):____W A6 <br />M <br />s�sl�o��55 <br />Under the authoritv of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />aotified 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 (3 k C, \ , you violated Section I -(Ao(` l the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wi you: <br />1 Z�N V Q =. P t3(T (i(— <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <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 It -1.074 you are entitled to an informal hearing to contcst this Notice. A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Dircctor ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt o f this Notice at the fol lowing address: 1820 Roosevelt, Blvd., Eugene, 0 R <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ofreecipt 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 />(SignatUre ol'person issuing/delivering 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 />White Copy: Publw Work Green Copy: File YcHow Copy: RcpoTt Cupy Pink Copy: Mxipicnu Gull Copy: Officer Appeal notice Rc%, 04103 <br />Narne: Last First Middle <br />DOB: <br />z <br />CC" " 1A Q Aj <br />U <br />Res. Add ss: city <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />7 <br />Under the authoritv of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />aotified 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 (3 k C, \ , you violated Section I -(Ao(` l the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wi you: <br />1 Z�N V Q =. P t3(T (i(— <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <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 It -1.074 you are entitled to an informal hearing to contcst this Notice. A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Dircctor ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt o f this Notice at the fol lowing address: 1820 Roosevelt, Blvd., Eugene, 0 R <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ofreecipt 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 />(SignatUre ol'person issuing/delivering 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 />White Copy: Publw Work Green Copy: File YcHow Copy: RcpoTt Cupy Pink Copy: Mxipicnu Gull Copy: Officer Appeal notice Rc%, 04103 <br />