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'1�0 I Y� <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: � .1 6 — I Z <br />LOCATION (PARK/OPEN SPACE): <br />C) I <br />TI: t � i � CASE . . ............................. . . ME � �2�j� 2 <br />- Co-n/ / J E2s 41/ F-A <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 />4 Entering in or using all City of Eugene parks, open spaces or facilities. <br />D t • u�� <br />The basis for this Notice of Restriction of Use is that on a T + � �"" � �' , you violated Section] of the Park <br />and Open Space Rules, and/or Section l fl of the Eugene Code, 1971, and/or ORS To wit, you: <br />l�V <br />LAN DScAV�D AOQ4 d' IN L n.� + AN/ <br />(Description of the violation.) 0 P N EY V A uco 0 OL <br />This restriction of use is effective beginning on 0 7 - 1 Y5_12-- and shall remain in effect until O � 5 —) v ` 1 ! <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 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. W 1 I. <br />(Signature of person being issued the notice) <br />Vhite Copy: Public Works Green Copy: File Yellow Copy: Report Copy Fink Copy: Recipient Gold Copy: officer Appeal notice Rev. 04103 <br />Nam : Last First Middle <br />DOB <br />Race/ e . <br />U <br />Res. At dress: 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 />4 Entering in or using all City of Eugene parks, open spaces or facilities. <br />D t • u�� <br />The basis for this Notice of Restriction of Use is that on a T + � �"" � �' , you violated Section] of the Park <br />and Open Space Rules, and/or Section l fl of the Eugene Code, 1971, and/or ORS To wit, you: <br />l�V <br />LAN DScAV�D AOQ4 d' IN L n.� + AN/ <br />(Description of the violation.) 0 P N EY V A uco 0 OL <br />This restriction of use is effective beginning on 0 7 - 1 Y5_12-- and shall remain in effect until O � 5 —) v ` 1 ! <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 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. W 1 I. <br />(Signature of person being issued the notice) <br />Vhite Copy: Public Works Green Copy: File Yellow Copy: Report Copy Fink Copy: Recipient Gold Copy: officer Appeal notice Rev. 04103 <br />