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NOTICE OF RESTRICTION OF USE <br />and Notice of Right <br />"toy Appeal <br />DATE: TIME: f�%�{J f� NI CASE #F <br />LOCATION (:PARK/OPF.N SPACE): <br />sv�s&&tiA'k <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 />XK 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 b , you violated Section of the Park <br />]: <br />This restriction of use is effective beginning on I� , 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 for an <br />informal hearing must he made in writing and filed with the Parks tic 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 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 informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Noticc, 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 regnested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice -it the an shown about by: <br />tiln73 <br />93 <br />(Signature of person is: uingldclivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />( ture of person being issued th roti <br />White Copy: Public Workc Green Copy: File YCllow Copy: Report Copy Pink Copy: Recipiunt Gold Cope: Officer Appeal notice Rev. 04,••03 <br />Middle <br />Nanie:pLast Firs n A),j <br />P013- 7 <br />Rlic •; 5 <br />xRe <br />ddress: City <br />�,(�� <br />Slate <br />Zip <br />Res. 1'luxt� <br />1•i•'ork Hione: <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 />XK 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 b , you violated Section of the Park <br />]: <br />This restriction of use is effective beginning on I� , 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 for an <br />informal hearing must he made in writing and filed with the Parks tic 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 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 informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Noticc, 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 regnested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice -it the an shown about by: <br />tiln73 <br />93 <br />(Signature of person is: uingldclivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />( ture of person being issued th roti <br />White Copy: Public Workc Green Copy: File YCllow Copy: Report Copy Pink Copy: Recipiunt Gold Cope: Officer Appeal notice Rev. 04,••03 <br />