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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DAM CASE # <br />tk gs�u <br />LOCATION (PAR `OPEN SPACE): ) ( V C <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 usiug all City of Eugene parks, open spaces or facilities. <br />FW <br />The basis for this Notice of Restriction of Use is that on c) q k C I , you violated Section a K (af the Park <br />and Open Space Rules, and/or Section q_-?_A&of the Eugene Code, 1971, and/or ORS To wit, you: <br />k( <br />(Pescription of the violation.) <br />This restriction of use is effective beginning on 04LOCD 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 R- 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 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 TCCIUCSt for hearing. At the intro n 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 of person issuing/d ivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Si nature of beirigg issued the'notice) <br />While, Copy: Public Works Green Copy: File Yellow Copy! Report Cap-- Pink Copy: Recipient G old Copy 0 fficer Appeal notice kek 04/03 <br />Namc: Last First Middle <br />DOB: � <br />6 <br />Race /Sex: <br />Res. Addrce: City <br />State <br />Zip <br />Res, 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 />Entering in or usiug all City of Eugene parks, open spaces or facilities. <br />FW <br />The basis for this Notice of Restriction of Use is that on c) q k C I , you violated Section a K (af the Park <br />and Open Space Rules, and/or Section q_-?_A&of the Eugene Code, 1971, and/or ORS To wit, you: <br />k( <br />(Pescription of the violation.) <br />This restriction of use is effective beginning on 04LOCD 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 R- 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 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 TCCIUCSt for hearing. At the intro n 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 of person issuing/d ivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Si nature of beirigg issued the'notice) <br />While, Copy: Public Works Green Copy: File Yellow Copy! Report Cap-- Pink Copy: Recipient G old Copy 0 fficer Appeal notice kek 04/03 <br />