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1 �51 15i *3 1 �
<br />NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />LI - DG
<br />DATE: i _ 11 TIME: In o f CASE #:
<br />LOCATION (PARK/OPEN SPACE): WAS[A Wk — "),J4 i�G, tm1
<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 thou are prohibited from (check box):
<br />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 1 you violated Section of the Park
<br />and Open Space Rules, and/or Section 4 1k,0 of the Eugene Code, 1971, and/or ORS To wit, you:
<br />R�q, tj�4 - n4z,J 14z, W4 L, )yoF -J -
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on 0 11 , and shall remain in effect until aAac .
<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 bearing 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 />d , laJJ -
<br />(Signature of person issuing/delivering notice)
<br />I hereby acknowledge receipt of the above Notice on the date and time indicated above.
<br />(. 1 10-" 1 "
<br />(S' ature of lv6on being issued the notice)
<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 First Middle
<br />DOB:
<br />Race /Sex:
<br />Res. Address: City
<br />State
<br />Zip
<br />Res. Phone:
<br />Work Phone:
<br />� X 4 Ad 4 1 s� iLou'.11k
<br />im
<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 thou are prohibited from (check box):
<br />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 1 you violated Section of the Park
<br />and Open Space Rules, and/or Section 4 1k,0 of the Eugene Code, 1971, and/or ORS To wit, you:
<br />R�q, tj�4 - n4z,J 14z, W4 L, )yoF -J -
<br />(Description of the violation.)
<br />This restriction of use is effective beginning on 0 11 , and shall remain in effect until aAac .
<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 bearing 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 />d , laJJ -
<br />(Signature of person issuing/delivering notice)
<br />I hereby acknowledge receipt of the above Notice on the date and time indicated above.
<br />(. 1 10-" 1 "
<br />(S' ature of lv6on being issued the notice)
<br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03
<br />
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