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I on <br />1 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE <br />LOCATION (PARK/OPEN SPACE): 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 />Entering in(i of Eugene parks, open spaces or facilities <br />CD <br />Lo) &J L, "' , <br />, W 3 rL I � I <br />lo I 1A/j � 4 rUT; "I � , 11 IeJ,114 � � 11 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 40 and shall remain in effeet 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, Arequest 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 />cey 01 --zlpt 01 u1c -quest 101 ficarifig—AT me informal nearing <br />consider testimony from you, City personnel involved in the incident that resulted in this N i <br />incident, The Div ision Director may exclude anyone, other than you and those presenting tes In <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, a/ date <br />Xnd time shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />&�anature of pperson e i n i u e dthe n o t i c e) <br />White Copy: Public Works Green Cspy: File Yelrow Copy: Report Copy Pink Copy. Recipient Gold Copy: Officer Appcai notice Rev. 04.'03 <br />Nance: Last First Middle <br />V j <br />- �- <br />&0 <br />DOB: <br />8" <br />Race/scy,: <br />/" <br />Res. Address: City <br />T <br />14 k6l� E <br />State <br />E� <br />Zip <br />= <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(i of Eugene parks, open spaces or facilities <br />CD <br />Lo) &J L, "' , <br />, W 3 rL I � I <br />lo I 1A/j � 4 rUT; "I � , 11 IeJ,114 � � 11 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 40 and shall remain in effeet 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, Arequest 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 />cey 01 --zlpt 01 u1c -quest 101 ficarifig—AT me informal nearing <br />consider testimony from you, City personnel involved in the incident that resulted in this N i <br />incident, The Div ision Director may exclude anyone, other than you and those presenting tes In <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, a/ date <br />Xnd time shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />&�anature of pperson e i n i u e dthe n o t i c e) <br />White Copy: Public Works Green Cspy: File Yelrow Copy: Report Copy Pink Copy. Recipient Gold Copy: Officer Appcai notice Rev. 04.'03 <br />