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DATE <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to,- Appeal <br />TIME: CASE #: <br />f <br />LOCATION (PARK/OPEN SPACE): <br />H <br />Name: Last , First Middle <br />DOB: <br />Race /Sex: <br />U Res. <br />Address: City Ts <br />Zip <br />Res. Phone: <br />Work Phone: <br />Under.tbe 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 />A Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restriction of Use is that on i` , you violated Section — _ of the Park. <br />and Open Space Rules, and /or Section of the Eugene Code, 1971, and /or ORS To wit, you: <br />(Description of the violation.) <br />�r <br />This restriction of use is effective beginning on , and shall remain in effect until <br />4, l z Lam. .� <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 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: 1 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 tl`° date and time shown above by: <br />(Signature of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />bite Copy: Public Works <br />(Signature of person being issued the notice) <br />.File Report Co ` 'nk Co Recipient Gold Copy: Officer Appeal notice Rev. 0 <br />Green Copy. Copy: p Copy Copy: P <br />