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' l-`! al"a <br />NOTICE OF RESTRICTION OF USE <br />DATE: l 1 5— <br />and Notice of Right to Appeal <br />TIME: l (0 <br />-Tdz lo ®d- c 9 <br />CASE #: t �)-- ` <br />— q q i -7 <br />LOCATION (PARK/OPEN SPACE) 0 ri <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 _ - you violated Section � l�C��f the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971; and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on I Cos'/ d- , and shall remain in effect until 20 5 <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 ofveekends) 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 we4ends) 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 the date and ti e shown above by: <br />of person issuing /delivering noti,;e) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person <br />issued the notice) <br />`a <br />:e Copy: Public Works Green Copy: File,, Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />40 f�y <br />Name: Last First <br />Middle <br />DOB: <br />Race /Sex: <br />z <br />a <br />.0.5- e0 �" y.Ltd <br />L-6- k2 <br />c t <br />$- �-���� <br />Res. Address: 3 .� City <br />State <br />Zi <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 _ - you violated Section � l�C��f the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971; and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on I Cos'/ d- , and shall remain in effect until 20 5 <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 ofveekends) 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 we4ends) 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 the date and ti e shown above by: <br />of person issuing /delivering noti,;e) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person <br />issued the notice) <br />`a <br />:e Copy: Public Works Green Copy: File,, Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />40 f�y <br />