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NOTICE OF RESTRICTION OF USE. <br />and notice. of Right to Appeal <br />DATE: L9+TIME: ' CASE #: I�7 r /5- <br />LOCATION (PARK/OPEN SPACE): <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 />A( 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 you violated Section _ r. Park <br />h )pen Space Rud • , and/or Section r 17 of the Eugene Code, 1971, and/or QRS To wit. you: <br />(Description of the violation.) ! <br />This restriction of use is effective beginning on )_,5- , and shall remain in effect until o <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) 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 Notice, anis 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 d time. shown above by: <br />(Signature of person ssuingldelivering notice) <br />I hereby acknowledge receipt of the above Notice on the [late and time indicated above. 'rte <br />J Ff. <br />�l <br />7 <br />[. ignature of pers6n Keing issued the notice) <br />White Copy: Public Works Grecn c-ry: File Ycllow Copy: Report Copy Pink Copy: Recipient Ci old Copy: Officer Apreal nvti¢c Rev. i:WV03 <br />Name: :Last Fri, addle <br />i) <br />1t u • S =x: <br />IQ- . , Phone;: <br />Work Phone: <br />. <br />Rett. d ss: L'it <br />ldit <br />State <br />%)� <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 />A( 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 you violated Section _ r. Park <br />h )pen Space Rud • , and/or Section r 17 of the Eugene Code, 1971, and/or QRS To wit. you: <br />(Description of the violation.) ! <br />This restriction of use is effective beginning on )_,5- , and shall remain in effect until o <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) 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 Notice, anis 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 d time. shown above by: <br />(Signature of person ssuingldelivering notice) <br />I hereby acknowledge receipt of the above Notice on the [late and time indicated above. 'rte <br />J Ff. <br />�l <br />7 <br />[. ignature of pers6n Keing issued the notice) <br />White Copy: Public Works Grecn c-ry: File Ycllow Copy: Report Copy Pink Copy: Recipient Ci old Copy: Officer Apreal nvti¢c Rev. i:WV03 <br />