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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: GH H, 2 TIME: A CASE #: q - ISE <br />— -- --------------- — __ — --------- <br />LOCATION (PARK/OPEN SPACE): _,4 <br />il� 1 <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 Dq J4 2,blS 1 you violated Section/. of the Park <br />(Description of The violation.) <br />This restriction of use is effective beginning on DY / 7b( —, and shall remain in effect until L&A 26- E3 <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 hide R - you are entitled to an informal hearing to contest thi N once. A request for an <br />infort 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 />97401 <br />The Division Director shall schedule a tirne 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 hearin the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this )N( tire, and other witnesses to the <br />.s <br />incident. The Division Director may exclude anyone, other than you and those presenting test' cony, from the infornial hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclus ion was delivered to the person named at the top of this NotiqVthe date and time shown above by: <br />peon issuing(delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />S-t-4�a <br />(,Signature of person being issued the notice) <br />White Copy! Public Works Green C'opy; File Yellow Copy: Repurt Copy Pink Copy! Recipient GW Copy: Offi c e r Appea € nonce Rev. 04"03 <br />— ------------------------------ - <br />Name: Last First Middle <br />DOB� <br />Race,"Sex: <br />. <br />Res. Address: City <br />state <br />dip <br />. . . . . . . <br />Res. Phone: <br />............ <br />Work llhone� <br />_-B Cal*_fauf ST�' <br />5`6 NW 57L <br />il� 1 <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 Dq J4 2,blS 1 you violated Section/. of the Park <br />(Description of The violation.) <br />This restriction of use is effective beginning on DY / 7b( —, and shall remain in effect until L&A 26- E3 <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 hide R - you are entitled to an informal hearing to contest thi N once. A request for an <br />infort 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 />97401 <br />The Division Director shall schedule a tirne 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 hearin the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this )N( tire, and other witnesses to the <br />.s <br />incident. The Division Director may exclude anyone, other than you and those presenting test' cony, from the infornial hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclus ion was delivered to the person named at the top of this NotiqVthe date and time shown above by: <br />peon issuing(delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />S-t-4�a <br />(,Signature of person being issued the notice) <br />White Copy! Public Works Green C'opy; File Yellow Copy: Repurt Copy Pink Copy! Recipient GW Copy: Offi c e r Appea € nonce Rev. 04"03 <br />— ------------------------------ - <br />