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NOTICE OF RESTRICTION OF USE lme,�s� jr,63 %Z �12- <br />and Notice of Right to Appeal <br />DATE: �a� � TIME: A . CASE #: <br />LOCATION (PARK /OPEN SPACE): 1 4 e <br />4�� <br />Under the authority ofAdministrative 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 <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 �-� ,you violated Section 00 of the Park <br />and Open Space Rules, and /or Section ` of the Eugene Code, 1971, and /or ORS To wit, you: <br />(De scrip tion of the violation.) <br />tt <br />This restriction of use is effective beginning on � and shall remain in effect until 1 2av) , <br />If you enter in or use any City of Eugene parr, 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 exctude 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 />A <br />k (Signature of person being issued the no <br />e C❑ Public works Green Co File Yellow Co Report PY� PY� Copy: P Copy Pink Copy: Recipient Gold Copy: officer Appeal notice Rev. 04143 <br />Name: Last <br />0j Fi t iddi <br />15 6A) <br />Do <br />Race) ex: <br />r <br />-�-� <br />Res. A r s: City <br />State Zip <br />� 14 <br />P ne: <br />Work Phone: <br />(� <br />6 d • <br />Under the authority ofAdministrative 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 <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 �-� ,you violated Section 00 of the Park <br />and Open Space Rules, and /or Section ` of the Eugene Code, 1971, and /or ORS To wit, you: <br />(De scrip tion of the violation.) <br />tt <br />This restriction of use is effective beginning on � and shall remain in effect until 1 2av) , <br />If you enter in or use any City of Eugene parr, 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 exctude 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 />A <br />k (Signature of person being issued the no <br />e C❑ Public works Green Co File Yellow Co Report PY� PY� Copy: P Copy Pink Copy: Recipient Gold Copy: officer Appeal notice Rev. 04143 <br />