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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME CASE <br />LOCATION (PARKJOPEN SPACE): <br />S <br />L"nder the authority of Administrative Order No. 58-03-24-F and Parkand Open Space Rule 11-1.005(3)you are hereby <br />notilied that you are prohihited from (check box)- <br />11 ntering in or using all City of Eugene parks, open spaces or facilities. <br />Cl <br />The basis for this Notice of Restriction of Use is that on you violated Section J LO L!4&)f the Park <br />and Open Space Rules, and/or Section _ of the Eugene Code, 1971, and/or ORS —,-1 To wit, you: <br />1 � 2 vc <br />(Description of the violation.) <br />This restriction of use is effective beginning on C <br />\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- I v07 4 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 Directol") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />- 1=17-1,71717 01177 S S neatue a urne ano p ace r1C 1111ul Mal nual nig to De conuu snail De <br />72 hour-, (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Dire7ctor will on <br />'i <br />tri <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal 1hearin <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/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signatri;e of iserson being Issued the noticel <br />While Copy: Public works Green Copy: He Yellow Copy: Report Copy Pink Copy Recipient Gold Copy: Officer Appeal notice Rev. 04,203 <br />Name: Last First Middle <br />DOB: <br />Racc/sex: <br />... .. ... ....... <br />. <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />L"nder the authority of Administrative Order No. 58-03-24-F and Parkand Open Space Rule 11-1.005(3)you are hereby <br />notilied that you are prohihited from (check box)- <br />11 ntering in or using all City of Eugene parks, open spaces or facilities. <br />Cl <br />The basis for this Notice of Restriction of Use is that on you violated Section J LO L!4&)f the Park <br />and Open Space Rules, and/or Section _ of the Eugene Code, 1971, and/or ORS —,-1 To wit, you: <br />1 � 2 vc <br />(Description of the violation.) <br />This restriction of use is effective beginning on C <br />\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- I v07 4 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 Directol") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />- 1=17-1,71717 01177 S S neatue a urne ano p ace r1C 1111ul Mal nual nig to De conuu snail De <br />72 hour-, (exclusive of weekends) of receipt of the request for hearing, At the informal hearing the Division Dire7ctor will on <br />'i <br />tri <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal 1hearin <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/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signatri;e of iserson being Issued the noticel <br />While Copy: Public works Green Copy: He Yellow Copy: Report Copy Pink Copy Recipient Gold Copy: Officer Appeal notice Rev. 04,203 <br />