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NOTICE OF RESTRICTION OF USE �` <br />and Notice of Right <br />l � Right to Appeal 0,5- 1tg O/. <br />l l ( 7 <br />DATE: C� 7 (" TIME: J / ©� CASE #: t C 7 & <br />LOCATION (PARK/OPEN SPACE): V °P- 8 04 S / , <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 />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 0 7 t of L<` , you violated Section A A ffof the Park <br />n and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />0655. t-K- C 07 O F M.I • �l -- 4 <br />(Description of the violation.) <br />This restriction of use is effective beginning on — 7 ( and shall remain in effect until 6 6 <br />i <br />Z 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 Not' fat the date and time shown above by: <br />Q� <br />i ature of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time ihdiCa #d above. <br />C '(Signqfiue of person 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 />N e: Last First <br />DOB <br />Rac / <br />`' l � Middle ( <br />066!f 6A LLdc <br />—7 <br />jAf <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <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 />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 0 7 t of L<` , you violated Section A A ffof the Park <br />n and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />0655. t-K- C 07 O F M.I • �l -- 4 <br />(Description of the violation.) <br />This restriction of use is effective beginning on — 7 ( and shall remain in effect until 6 6 <br />i <br />Z 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 Not' fat the date and time shown above by: <br />Q� <br />i ature of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time ihdiCa #d above. <br />C '(Signqfiue of person 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 />