NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 1a J TIME: cot CASE #: <br />(e - � 'M9 <br />/ca�o( w oe` /3 <br />. 5AS. <br />LOCATION (PARK/OPEN SPACE): ar/ G GI /1SN? .v /, i 4, <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 1 7 you violated Section . U O of the Park <br />and Open Space Rules, and/or Section _ ofthe Eugene Code, 19W"d/or ORS L1. a 6 /0 To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on ,? /Q S - 1 and shall remain in effect until O! /C'3 <br />3 <br />/t . <br />If you enter in or use any City of Eugene park, open�sP thi <br />ce or facility during the effective period of s Notice, you may be <br />arrested.and charged with criminal trespass in the ke�bo nd degree: <br />Pursuant to Park and Open Space Rule R- 1.0,*ou are entitled to an informal hearing to contest this Notice. A request for an <br />informal hearing must be made in writ' n filed with the Parks & Open Space Division Director ( "the Division Director) <br />within 48 hours (exclusive of weekends) , rreceipt 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 Notice at the date and time shown above by: <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 1 <br />. A # (Signature of person being issued the notice) <br />t <br />y <br />White Copy: Public Works Green Copy File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal rwtice Rev. 04/03 <br />Name: Last . First Middle <br />DOB: <br />Race /Sex: <br />W <br />AAAR - r t—r. fit) ^; -t C A+Ar -9ndV <br />(73 <br />(A )IM <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 1 7 you violated Section . U O of the Park <br />and Open Space Rules, and/or Section _ ofthe Eugene Code, 19W"d/or ORS L1. a 6 /0 To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on ,? /Q S - 1 and shall remain in effect until O! /C'3 <br />3 <br />/t . <br />If you enter in or use any City of Eugene park, open�sP thi <br />ce or facility during the effective period of s Notice, you may be <br />arrested.and charged with criminal trespass in the ke�bo nd degree: <br />Pursuant to Park and Open Space Rule R- 1.0,*ou are entitled to an informal hearing to contest this Notice. A request for an <br />informal hearing must be made in writ' n filed with the Parks & Open Space Division Director ( "the Division Director) <br />within 48 hours (exclusive of weekends) , rreceipt 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 Notice at the date and time shown above by: <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 1 <br />. A # (Signature of person being issued the notice) <br />t <br />y <br />White Copy: Public Works Green Copy File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal rwtice Rev. 04/03 <br />