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NU'I'ICE. OF 1tESTRICTI[)'tiI OF USIJ c6kAcj IV <br />and Notice of Right to Appeal <br />DATE:(] l TIME: CASE #: <br />LOCATION (PARK/OPEN SPAC:'E);�f�-- <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 arc prohibited from (check box): <br />13� 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 09 U V 1 r , you violated Section of the Park <br />and Open Space Rules, and/or Section — it �� of the Eugene Code, 1971, and/or DRS To wit, you: <br />a UOA tin" rF R A' 61E6 <br />rj <br />V� <br />(Description ot'the violation.) <br />Tbis restriction of use is effective beginning on D , and shall remain in effect until 1� <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) oFrcceipt 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 presen t stimony, 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 ol'thi o ice at the. date and time shown above by: <br />Signatur of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature.fperson being issue the notice) <br />White Fopy: Public Works Green Copy: File Yellow Copy Repon Copy Pink Copy: Rktiipicnt Void Copy: Officer Appeal notice Rc%, 04103 <br />Nanta. Last Firs( rylidWe <br />DOB: <br />R CC,ls <br />Y%1 Jk klim <br />M)- <br />Rr s. Address: Citi <br />state <br />Zip <br />1Zes- Phone: <br />Work Phone: <br />f,"^iy`,til <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 arc prohibited from (check box): <br />13� 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 09 U V 1 r , you violated Section of the Park <br />and Open Space Rules, and/or Section — it �� of the Eugene Code, 1971, and/or DRS To wit, you: <br />a UOA tin" rF R A' 61E6 <br />rj <br />V� <br />(Description ot'the violation.) <br />Tbis restriction of use is effective beginning on D , and shall remain in effect until 1� <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) oFrcceipt 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 presen t stimony, 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 ol'thi o ice at the. date and time shown above by: <br />Signatur of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature.fperson being issue the notice) <br />White Fopy: Public Works Green Copy: File Yellow Copy Repon Copy Pink Copy: Rktiipicnt Void Copy: Officer Appeal notice Rc%, 04103 <br />