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NOTICE OF RESTRICTION OF USE �' C3 5�AL�aR <br />and Notice of Right to Appeal <br />DATE:09247r>-TIME: llp4b M CASF. #: S <br />LOCATION (PARK/OPEN SPAC"F):Aj�5kt—jQ(i- Sr, s _ <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Spa cc 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 />The basis for this Notice of Restriction off Use is that on you violated Section • 0 of the Park <br />and Open Space Rules, andior Section F/ i of the Fugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on 7 , and shall refrain in effect until 5 7 <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 />within48 hours (exclusive of weekends) of receipt 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 in formal hearing the Division Director wilt 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 refrain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this lti'o' ate an time shown above by: <br />(Signature off) rsonis5uingldelir°ening notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated abo <br />(Signatu <br />White Copy: Public Works Green Copy: Filc Yellow Copy: Report Copy Pink Copy: Recipient Gold Cagy: O icci ;appeal notice Rets. 04.0 <br />Name: Tr <br />j -HrM <br />Middle <br />D013: <br />Race/ ex: <br />Reti. dresv: <br />C4 <br />State <br />lip <br />Re!s.. Phone- <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Spa cc 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 />The basis for this Notice of Restriction off Use is that on you violated Section • 0 of the Park <br />and Open Space Rules, andior Section F/ i of the Fugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on 7 , and shall refrain in effect until 5 7 <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 />within48 hours (exclusive of weekends) of receipt 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 in formal hearing the Division Director wilt 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 refrain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this lti'o' ate an time shown above by: <br />(Signature off) rsonis5uingldelir°ening notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated abo <br />(Signatu <br />White Copy: Public Works Green Copy: Filc Yellow Copy: Report Copy Pink Copy: Recipient Gold Cagy: O icci ;appeal notice Rets. 04.0 <br />