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NOTICE OF REs TIT N OF USE <br />and Notice of Right to Appeal <br />DATE: (- f 1, e ly 5- <br />TIME: 1-;V ) -I-li CASE #: <br />LOCATION (PARK, SPACE):_ M A44 _� A-epn — -- - --------- <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 />W Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restriction of Use is that on <br />0 1 -5 you violated Section I. Ol <br />,)Of the Park <br />and Open Space Rules, and/or Section I of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until — 4 1 jo <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 info al hearing to contest this Notice. A request for an <br />info al hearing must be made in writing and tiled 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 informal 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 or Exclusion was delivered to the person named at the top of this Notice at the da d time shown above by: <br />(Signature of 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; Public Wor" Grccn Copy: File Yellow Copy Repon C0PV Pink Copy: Recipient Gold Copy: Offik:s r Appal notiwr Rcv. 04M3 <br />Narnc� Last First Middle <br />DOB� <br />Race/Slx: <br />4 <br />U4 <br />Spo- ks- AOf &&-k <br />LL: <br />Items. Address: city <br />Mate <br />dip <br />des. 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 />notified that you are prohibited from (check box): <br />W Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restriction of Use is that on <br />0 1 -5 you violated Section I. Ol <br />,)Of the Park <br />and Open Space Rules, and/or Section I of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until — 4 1 jo <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 info al hearing to contest this Notice. A request for an <br />info al hearing must be made in writing and tiled 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 informal 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 or Exclusion was delivered to the person named at the top of this Notice at the da d time shown above by: <br />(Signature of 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; Public Wor" Grccn Copy: File Yellow Copy Repon C0PV Pink Copy: Recipient Gold Copy: Offik:s r Appal notiwr Rcv. 04M3 <br />