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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CO CASE #,: <br />LOCATION (PARK/OPEN SPACE): 11 ) - _rf� 0 <br />7 9 <br />Q <br />I b - 5 t-P -+ <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 <br />_L of 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 and shall remain in effect until <br />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 49 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 anvone, other than you and those presenting testimony, from the in al 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 Noti c date and tinie shown above bv <br />(Signatu notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person being issued the notice) <br />White Copy: Pubfic Works Green Copy. File YeHow 4 opy: Report Copy PiA Copy! Recipient Gold Copy: Officer Appeal notice Rm 04A)3 <br />First Middle <br />DOB <br />z <br />r 1 G_ <br />' Y C <br />" <br />(L( r. <br />— i <br />S -5 1 1 <br />-, "2, <br />Res. Address: <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />I b - 5 t-P -+ <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 <br />_L of 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 and shall remain in effect until <br />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 49 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 anvone, other than you and those presenting testimony, from the in al 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 Noti c date and tinie shown above bv <br />(Signatu notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person being issued the notice) <br />White Copy: Pubfic Works Green Copy. File YeHow 4 opy: Report Copy PiA Copy! Recipient Gold Copy: Officer Appeal notice Rm 04A)3 <br />