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��sj X235 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: ed )" {yrs, CASE. #: <br />LOCATION (PARK/OPEN SPACE): 5,o L t'0 <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 />Off Entering in or using all City of Eugene parks, open spaces or facilities. <br />Fl <br />The basis far this Notice of Restriction of Use is that on I GI you violated Section C- a1_ �y f the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />W nw P IL <br />(Description of the violation.) <br />7�/ This restriction of use is effective beginning on C7 1 , 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-1.074 you are entitled to an informal hearing to contest this Notice. A request far 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 Dircctor shall schcduic 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 remain in effect pending; any requested hearing. <br />This Notice of'Exclusion was delivered to the person named at the top of this Noti a date and time shown above by: <br />.� 4k'CK4'+` I t d <br />(Signature of person issuingldelivcring notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />a\ream �rs�s <br />(Signature of person being issued the notice) <br />,od'r Jwt T int <br />White Copy: Public Works Green Cope: File Yellow Copy: Report Copy Pink Copy: Recipient ❑old Copy. Officer Appeal notice <br />Rev- 04103 <br />Mame: Last First �Yrdttic <br />17013: <br />Race/s - ' <br />Res. Address: city <br />State <br />Zip <br />Res. Phone: <br />Work Phonc: <br />TIM) va AF <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 />Off Entering in or using all City of Eugene parks, open spaces or facilities. <br />Fl <br />The basis far this Notice of Restriction of Use is that on I GI you violated Section C- a1_ �y f the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />W nw P IL <br />(Description of the violation.) <br />7�/ This restriction of use is effective beginning on C7 1 , 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-1.074 you are entitled to an informal hearing to contest this Notice. A request far 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 Dircctor shall schcduic 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 remain in effect pending; any requested hearing. <br />This Notice of'Exclusion was delivered to the person named at the top of this Noti a date and time shown above by: <br />.� 4k'CK4'+` I t d <br />(Signature of person issuingldelivcring notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />a\ream �rs�s <br />(Signature of person being issued the notice) <br />,od'r Jwt T int <br />White Copy: Public Works Green Cope: File Yellow Copy: Report Copy Pink Copy: Recipient ❑old Copy. Officer Appeal notice <br />Rev- 04103 <br />