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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: <br />LOCATION (PARK/OPEN SPACE) <br />TIME: <br />P, le- <br />;1d / <br />M <br />CASE #: <br /><1 /_ <br />Under the authority of Administr=o. 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 AA you violated Section <br />and Open Space Rules, andlor Section_y to - 7 of the Eugene Code, 1971, and/or ORS <br />(Description of the violation.) <br />/6/ of the Park <br />This restriction of use is effective beginning onl—&o �-/, 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 T3 - 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 />- am <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 />(Siinllaturebf person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(S' gnat f person beAiingis4 ed the notice) <br />gnat I <br />o <br />White Copy, Public Wurks Green Copy: File Yellow Copy_ Report Copy Pink Cupy. Recipient Guld Copy: Officer Appeal notice Rev. 04A)3 <br />Nature: first ddle <br />'All <br />Raeo/sex: <br />R; s. 4ress: City <br />State <br />Zip <br />Res, Phone: <br />Work Phone: <br />. .......................... . ..... <br />Under the authority of Administr=o. 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 AA you violated Section <br />and Open Space Rules, andlor Section_y to - 7 of the Eugene Code, 1971, and/or ORS <br />(Description of the violation.) <br />/6/ of the Park <br />This restriction of use is effective beginning onl—&o �-/, 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 T3 - 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 />- am <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 />(Siinllaturebf person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(S' gnat f person beAiingis4 ed the notice) <br />gnat I <br />o <br />White Copy, Public Wurks Green Copy: File Yellow Copy_ Report Copy Pink Cupy. Recipient Guld Copy: Officer Appeal notice Rev. 04A)3 <br />