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V��35sl' <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: / 0 Q— <br />LOCATION (PARK/OPEN SPACE) <br />TIME: <br />04't c( r <br />(O c/lc <br />9�y <br />CASE#: 12 - 190J <br />G 4 (c f <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 />ii <br />The basis for this Notice of Restriction of Use is that on l you violated Q- ctiop, R of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS 47611 9 0LI T wit you: <br />V=. C XV rZP A( 4F MA ZX `(A4At4 WZCT`VvQQ l f 060"' 'OF S�`LOeG �� ��'' <br />� <br />0 UrV O E01 6f- MAe -- =W4AJA a'r6 A4 MX <br />F'Ct L 0 0 S S ®f MA - &zr.:3 <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until Of . <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 r ol-" the date and time shown above by: <br />7-) <br />person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time <br />(Signature of person being issued the notice) <br />I <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />Name: Last <br />First Middle <br />DOB: <br />Race/Sex/ <br />z <br />L® co ft�,vi <br />& Pt y AFIP <br />Qj R5 ?7 <br />&J m <br />Res. Address: <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />T-kA-,tJ 5 : &W I <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 />ii <br />The basis for this Notice of Restriction of Use is that on l you violated Q- ctiop, R of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS 47611 9 0LI T wit you: <br />V=. C XV rZP A( 4F MA ZX `(A4At4 WZCT`VvQQ l f 060"' 'OF S�`LOeG �� ��'' <br />� <br />0 UrV O E01 6f- MAe -- =W4AJA a'r6 A4 MX <br />F'Ct L 0 0 S S ®f MA - &zr.:3 <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until Of . <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 r ol-" the date and time shown above by: <br />7-) <br />person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time <br />(Signature of person being issued the notice) <br />I <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />