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NOTICE OF RESTRIC iON OF USE <br />.And Notice of Right to Appeal <br />DATE: 'TIME; �� p��'1 CASF <br />LOCATION (PARK/OPEN SPACE): W ;�- tFAx )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 />L� <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on J -1t rl 1 you violated Section t 01 q(tq1of 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.) A'b <br />phis restriction of use is effective beginning on ] C4 , 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 irnf'ormal hearing to contest this Notice. A request furan <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 reccipt oFthis 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 he 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 test o y, 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 Not- e • ie date and time shown above by: <br />r <br />nature of person issuing!dOlvering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature ofperson being issued the notice) <br />White Copy. Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy. Recipient Gold Copy: Officer Appcai notice kcv, (W03 <br />Name: Lastk First Middlc <br />Df 1 : <br />a acs 5t <br />17 <br />Res. Aiiilr s. City <br />Stale <br />Zip <br />Res. Phone: <br />Work Thome: <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 />L� <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on J -1t rl 1 you violated Section t 01 q(tq1of 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.) A'b <br />phis restriction of use is effective beginning on ] C4 , 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 irnf'ormal hearing to contest this Notice. A request furan <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 reccipt oFthis 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 he 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 test o y, 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 Not- e • ie date and time shown above by: <br />r <br />nature of person issuing!dOlvering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature ofperson being issued the notice) <br />White Copy. Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy. Recipient Gold Copy: Officer Appcai notice kcv, (W03 <br />