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0 q 0 � 1 9 NOTICE OF RESTRICTION OF USE <br />LOCATION (PARK/OPEN SPACE): W 65 (�� k _-A IVC,16� <br />5�5 � 1 4�1 �\ <br />J nder the authority o F Administrative Order No. 58-03-24-F and Park and Open Space R u le R- 1.005(3), you are hereby <br />.jotified that you are prohibited from (check box), <br />$ in or using all City of Eugene parks, open spaces or facilities,, <br />M <br />The basis for this Notice of Restriction of Use is that on 8 ti you violated Section L_ b— of the Park <br />and Open Space Rules, and/or Section 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 of until -ts. <br />If you enter in or Use any City of Eugene park, open space or facility during the effective period or this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pun-mant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A request 60r an <br />i n1lornial hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive o I'weekends) of receipt of this Notice at the following address: 1820 Roosevelt, B1v d., Eugene, 0R <br />97402. <br />M d k[111F_ d11U Itor L, i I OV HUL 111401 U 11 <br />W <br />72 hours (,exclusive of weekends) of receipt of the request for hearing. At the infortnal 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, fTom the inforrnal hearing. <br />'rhis 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 Not . at the date dVid time shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time inc icaA above. <br />ib ge �isswed <br />(Signature of person the notice) <br />Whrie, Copy: Public Workti Green Copy. File Yellow Copy: Report 0 Ppy Pink Copy: Rccipu�nt Gold Cop - i Officer Appeal noitet Rev, (AM3 <br />Name: Last First <br />: <br />DOB' <br />DOB <br />R -�Ice/s -m <br />jNfiddle <br />M)'TUJ AM <br />q i <br />FPhone: <br />Res. Address: City <br />State <br />Zip <br />Res, <br />Work Phone: <br />J nder the authority o F Administrative Order No. 58-03-24-F and Park and Open Space R u le R- 1.005(3), you are hereby <br />.jotified that you are prohibited from (check box), <br />$ in or using all City of Eugene parks, open spaces or facilities,, <br />M <br />The basis for this Notice of Restriction of Use is that on 8 ti you violated Section L_ b— of the Park <br />and Open Space Rules, and/or Section 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 of until -ts. <br />If you enter in or Use any City of Eugene park, open space or facility during the effective period or this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pun-mant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A request 60r an <br />i n1lornial hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive o I'weekends) of receipt of this Notice at the following address: 1820 Roosevelt, B1v d., Eugene, 0R <br />97402. <br />M d k[111F_ d11U Itor L, i I OV HUL 111401 U 11 <br />W <br />72 hours (,exclusive of weekends) of receipt of the request for hearing. At the infortnal 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, fTom the inforrnal hearing. <br />'rhis 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 Not . at the date dVid time shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time inc icaA above. <br />ib ge �isswed <br />(Signature of person the notice) <br />Whrie, Copy: Public Workti Green Copy. File Yellow Copy: Report 0 Ppy Pink Copy: Rccipu�nt Gold Cop - i Officer Appeal noitet Rev, (AM3 <br />