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NOTICE OF RESTRICTION OF CASE <br />and Notice of Right to Appeal <br />DATE: 'ZZ ' i' TIME: i� = 7-8 P+'°'1 CASE #: <br />LOCATION (PARK/OPEN SPACE): <br />CLrk <br />S►��� Pa rr-�c <br />Under the authority of Administrative Order No. 58-03-24-1a 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 />d <br />The basis for this Notice of Restriction of Use is that on 22 t you violated Section of the Park <br />and Open Space Rules, and/or Section I r V 1 b of the Eugene Code, 1971, and/or ORS . To wit, you: <br />C- PSN. P C -D I N h C 1 r;� P A rk- <br />(Description of the. violation.) <br />'Chis restriction of use is effective beginning on �-� -i �, and shall remain in effect until E j <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) oCre.ceipt of this 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 be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infoormal 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 Notice at the date and time shown above. by: <br />(5i n urc person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued t otice) <br />Whi4: Copy. Pubiic Works Green Copy: rile Fellow Copy. Report Copy Pink Copy. Rccipicnt Gold Copy: Officer Appeal notice Rev. 04/03 <br />Name: Last First diddle <br />DOFi: <br />R,ice'Se.x: <br />Res. Address: City <br />Statc <br />Zip <br />Rcs. Phone: <br />Work Phone: <br />'TP—Ali `su�►--sem` <br />Under the authority of Administrative Order No. 58-03-24-1a 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 />d <br />The basis for this Notice of Restriction of Use is that on 22 t you violated Section of the Park <br />and Open Space Rules, and/or Section I r V 1 b of the Eugene Code, 1971, and/or ORS . To wit, you: <br />C- PSN. P C -D I N h C 1 r;� P A rk- <br />(Description of the. violation.) <br />'Chis restriction of use is effective beginning on �-� -i �, and shall remain in effect until E j <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) oCre.ceipt of this 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 be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infoormal 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 Notice at the date and time shown above. by: <br />(5i n urc person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued t otice) <br />Whi4: Copy. Pubiic Works Green Copy: rile Fellow Copy. Report Copy Pink Copy. Rccipicnt Gold Copy: Officer Appeal notice Rev. 04/03 <br />