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I Oro C� _ '20q r <br />NOTICE OF RESTRICTION OF USE <br />/ q ` and Notice o to Appeal <br />DATE: Cl � [ [ TIME: h3 4 f 57 CASE <br />LOCATION (PARK/OPEN SPACE): W X <br />OL 36�' — <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 />X 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 � f' you violated Section ©1 T of the Park <br />and Open Space Rules, and/or See rioli of the Eugene Code, 1971, and/or ORS To wit, you: <br />C012 t(L Co FFO L (SoD.b i1 Q t-S' �tvcy ®� �� �f Ries �t�Vl1` PAY K'k L <br />(Description of the violation.) <br />r This restriction of use is effective beginning on f;Z-Q / t 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 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, 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 N 'ce / e dat��e�showylal£ove by: <br />(Signature of person issuin`7delivering notice) / <br />I hereby acknowledge receipt of the above Notice on the date and time indicatedabove. <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />Name: Last <br />ST <br />First Middle <br />(5 kA 71 <br />DOB: <br />d o Sd' <br />Race /Sex: <br />R dress: <br />` <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />N,� <br />o �� G <br />�l� <br />Z <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 />X 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 � f' you violated Section ©1 T of the Park <br />and Open Space Rules, and/or See rioli of the Eugene Code, 1971, and/or ORS To wit, you: <br />C012 t(L Co FFO L (SoD.b i1 Q t-S' �tvcy ®� �� �f Ries �t�Vl1` PAY K'k L <br />(Description of the violation.) <br />r This restriction of use is effective beginning on f;Z-Q / t 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 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, 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 N 'ce / e dat��e�showylal£ove by: <br />(Signature of person issuin`7delivering notice) / <br />I hereby acknowledge receipt of the above Notice on the date and time indicatedabove. <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />