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NOTICE OF RESTRICTION OF USE <br />CA <br />DATE <br />-CA <br />TIME: J CASE <br />LOCATION (PARK/0PEN <br />III III 111 1 , i I Jill I ill iiiiii�ll I <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on g you violated Section I Q I I I <br />k Q wft`4 the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or CIRS _. To wit, you:_ <br />F- <br />(Description of the violation.) (>IS I <br />I <br />This restriction of use is effective beginning on 0 L l I C nd shall remain in effect until <br />a C D 16 1 E) <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 informal 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 ol'weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97401 <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 re ain 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 ahove by: <br />(Signature of person issuing/delliering! <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- Y <br />(Signature of'person being issued the notice) <br />White Copyy PubI4. Works Green Copy: File YCHOW Copy: Report 4 opy Pink Copy: Recipitnt Gull C opy: 0 M cer A ppeal nol icc Rev- W/03 <br />Nanie: Last First Middle <br />DOB: <br />Race/Sex. <br />Res, Address: city <br />State <br />Zip <br />Zip <br />Res. Phone: <br />Work Phil)= <br />III III 111 1 , i I Jill I ill iiiiii�ll I <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on g you violated Section I Q I I I <br />k Q wft`4 the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or CIRS _. To wit, you:_ <br />F- <br />(Description of the violation.) (>IS I <br />I <br />This restriction of use is effective beginning on 0 L l I C nd shall remain in effect until <br />a C D 16 1 E) <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 informal 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 ol'weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97401 <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 re ain 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 ahove by: <br />(Signature of person issuing/delliering! <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- Y <br />(Signature of'person being issued the notice) <br />White Copyy PubI4. Works Green Copy: File YCHOW Copy: Report 4 opy Pink Copy: Recipitnt Gull C opy: 0 M cer A ppeal nol icc Rev- W/03 <br />