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DATE: G L q L <br />LOCATION (PARK/OPEN SPACE): <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to�� Appeal <br />TIME: 0 6 \" 4 <br />ff � CASE # <br />4 1 a -zzY-r <br />14 — q q b <br />W <br />Name: Last Fi Middl <br />4 Oty <br />DOB: <br />oci EGG <br />Race /Sex: <br />a <br />f4� <br />W LN\ <br />U <br />Res. Addres City <br />State Zip <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- 1.405(3), you are hereby <br />notified that you are prohibited from (check box): <br />YD 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 6 -�> k 9 Y , you violated Section of the Park <br />and Open Space Rules, and/or Section 1 0 �6 1 4 11 the Eugene Code, 1971, and/or DRS To wit, you: <br />(Description of the violation.) f� <br />This restriction of use is effective beginning on 6 - \9 , , and shall remain in effect until 6 1 i <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 trust 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 />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 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 />�� /(1 <br />(Signature of person issuing)delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />X — <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />