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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE� TIME� CASE4: <br />— --------- - <br />LOCATION (PARK/OPEN SPACE). Zr <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 frorn (check box)- <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />MW <br />The basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />an -) i� d Open Space Rules, and/or Section of the Eugene Code, 197 1, and/or OR SV " To wit, you: <br />Ie Y\ t <br />(Description of the violation.) <br />T his restriction of use is effective beginning on 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 R-1.074 you are entitled to all infornial hearing to contest this Notice. Arequestforant <br />ni6onnat 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 />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />7 2 hours (exclusive of weekends) of receipt oi' 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 />mcident. The Division Director may exclude anyone, other than you and those presenting testiniony, 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 />e <br />. .... ..... ... .. ...... <br />(Signs lure o!"person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signatureofper. )n fissued the notice) <br />While Copy: Puhli,2 Works Green Copy: Fite Yello" Copy RcporlCopy Pink Copy: Recipient GnId Copy: Officer Appeal notice Rev, 04!(13 <br />Name: Lasi First Middle <br />DOB: <br />Race/sex: <br />(4-1 Itq <br />Res. Address: -i y <br />CY <br />state I Zip <br />Res. Phc <br />Work Phone: <br />Cd <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 frorn (check box)- <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />MW <br />The basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />an -) i� d Open Space Rules, and/or Section of the Eugene Code, 197 1, and/or OR SV " To wit, you: <br />Ie Y\ t <br />(Description of the violation.) <br />T his restriction of use is effective beginning on 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 R-1.074 you are entitled to all infornial hearing to contest this Notice. Arequestforant <br />ni6onnat 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 />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />7 2 hours (exclusive of weekends) of receipt oi' 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 />mcident. The Division Director may exclude anyone, other than you and those presenting testiniony, 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 />e <br />. .... ..... ... .. ...... <br />(Signs lure o!"person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signatureofper. )n fissued the notice) <br />While Copy: Puhli,2 Works Green Copy: Fite Yello" Copy RcporlCopy Pink Copy: Recipient GnId Copy: Officer Appeal notice Rev, 04!(13 <br />