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l- ti � 4 -. .. • T.ti� �^m� - i <br />NOTICE OF RESTRICTION' OF USE q6 <br />and Notice of Right 0.'Appeal <br />1 r •. , <br />DATE:., TIME: ,r. -,r -CASE #: _ <br />LOCATION (PARK/OPEN SPACE): <br />Under the authority of Administrative order No. 58- 43 -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 l a , you violated Section 0 of the Park <br />I <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or DRS To wit, you: 7) <br />(Description of the violation.) <br />Of use js effective beginning 9 and shall remain in effect until 7 4 1 I.- C . <br />This restriction o g g on <br />If Y ou enter in or use any City of Eugene park, open space or facility during the'effective period of this Notice, you may be t <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 />1 ' N <br />97442. <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 hearing. At the informal hearing 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 a�she date and time shown above by: <br />ignature of person issuing /delivering notice} <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />L/ It 1 ' 1 <br />(Signature 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. D4Ia3 • - '., <br />Name: Last <br />First Middle <br />k <br />DDB: <br />Race /Sex: <br />w <br />VIA4A L iv sv <br />A <br />0. <br />U <br />wl <br />Res. Address: <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />-T <br />Under the authority of Administrative order No. 58- 43 -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 l a , you violated Section 0 of the Park <br />I <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or DRS To wit, you: 7) <br />(Description of the violation.) <br />Of use js effective beginning 9 and shall remain in effect until 7 4 1 I.- C . <br />This restriction o g g on <br />If Y ou enter in or use any City of Eugene park, open space or facility during the'effective period of this Notice, you may be t <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 />1 ' N <br />97442. <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 hearing. At the informal hearing 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 a�she date and time shown above by: <br />ignature of person issuing /delivering notice} <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />L/ It 1 ' 1 <br />(Signature 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. D4Ia3 • - '., <br />