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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: Or , / ;� <br />TIME: CASE #: <br />LOCATION ( PARK /OPEN SPACE):__/�'CrfjQl� <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 />9 Entering in or using all City of Eugene parks, open spaces or facilities. <br />■❑ <br />The basis for this Notice of Restriction of Use is that on ou violated Section � f th -a <br />y o h Park <br />and Open Space Rules, and/or Section 4 9/ , 5 of the Eugene Code, 1.971, and/or ORS To wit, you: <br />6Ro�M,rt�� <br />OAMPIA16 <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <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 N tice at the ate 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 in ' e ve. <br />ignature of pe einglssued the notice) <br />White Copy: Public works Green Copy. File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04143 <br />Name: Last First Middle <br />DOB: <br />Race /Se <br />a <br />0.10 <br />,, <br />0 1--./-o ­g <br />Res. Address: City <br />State <br />,Zip <br />Res. Phone: <br />work Phone: <br />s <br />Ems Jt j <br />.. _L <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 />9 Entering in or using all City of Eugene parks, open spaces or facilities. <br />■❑ <br />The basis for this Notice of Restriction of Use is that on ou violated Section � f th -a <br />y o h Park <br />and Open Space Rules, and/or Section 4 9/ , 5 of the Eugene Code, 1.971, and/or ORS To wit, you: <br />6Ro�M,rt�� <br />OAMPIA16 <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <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 N tice at the ate 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 in ' e ve. <br />ignature of pe einglssued the notice) <br />White Copy: Public works Green Copy. File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04143 <br />