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NOTICE OF RESTRICTION OF USE 5� � <br />and Notice of Right to Appeal I 7 <br />DATE: GI /05 — TIME: ac CASE #: <br />LOCATION (PARKIOPEN SPACE): 1, <br />1 <br />Ender the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereb►• <br />notified that you are prohibited from (check box): <br />9— 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 onoT —0S i l- 5 , you violated Section LQ of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or DRS To wit, you: <br />(Description of the violation.) [ <br />This restriction of use is effective beginning on ?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 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 ii-El'irmal 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, 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 />(Signature of person issutn ce) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signatur -e&p rsoneing issued the notice) <br />White Copy- Public Works Green Copy: File Yellow Copy: Repor: Copy Pink Copy Recipient Guld Capy: Officer Appeal notice Rev. 04103 <br />Name: Last First Middle DOS: � <br />'Rae"5e. <br />.J <br />Res. Address; City <br />State <br />Zip Res. Phone: <br />Work Phone: <br />VII <br />Ender the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereb►• <br />notified that you are prohibited from (check box): <br />9— 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 onoT —0S i l- 5 , you violated Section LQ of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or DRS To wit, you: <br />(Description of the violation.) [ <br />This restriction of use is effective beginning on ?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 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 ii-El'irmal 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, 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 />(Signature of person issutn ce) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signatur -e&p rsoneing issued the notice) <br />White Copy- Public Works Green Copy: File Yellow Copy: Repor: Copy Pink Copy Recipient Guld Capy: Officer Appeal notice Rev. 04103 <br />