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NOTICE OF RESTRICTION OF USE b\AS�5wpj <br />and Notice of Right to Appeal <br />DATE, TIME: CASE <br />LOCATION (PAR /OPEN SPACE): <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 using all City of Eugene parks, open spaces or facilities. <br />F] <br />(Description of the violation.) <br />This restriction of use is effective beginning on 6 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 -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 of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97401 <br />W11111111111 in ji i I iii <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and othe�rwitnesses to t <br />o t <br />,I I rm <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infonnal hearin <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 s wri above by: <br />< <br />(Signature of person issuing/ elivering 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 Works Green Copy: Fitc Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />Name. L t First r Middle <br />v <br />DOB: <br />R 'S <br />Res. Address: City <br />` <br />I <br />Z17P <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 using all City of Eugene parks, open spaces or facilities. <br />F] <br />(Description of the violation.) <br />This restriction of use is effective beginning on 6 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 -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 of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97401 <br />W11111111111 in ji i I iii <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and othe�rwitnesses to t <br />o t <br />,I I rm <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infonnal hearin <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 s wri above by: <br />< <br />(Signature of person issuing/ elivering 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 Works Green Copy: Fitc Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />