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NOTICE OF RESTRICTION OF USE <br />T and Notice of Right to Appeal <br />DATE: t' TIME: t. <br />CASE #: <br />LOCATION (PAWOPEN SPACE): <br />Name: Las Fire Middle DOB: Race /Sex: <br />t .. <br />Res. Address: City State Zip L R�es.Phone: Work Phone: <br />e <br />rider the authority of Administrative Order N6. 58-03-24-F and Park and Open Space Rule R- 1.005(3), you <br />'otified that ou are prohibited from check box ` <br />y P ( ) Tadash�Abash; Q�,,.la;l.Com <br />Entering in or. using all .City of E' i gene parks, open spaces or facilities. <br />k <br />I <br />�e basis fot;thii'Notice of Restriction E on ` , you violated Section ^, 4 ; °^ of the Park <br />ad Open Space Rules, and/or Section of the Eugene Code, 1971,4tnd/or QRS To wit, you: <br />/ <br />6escn <br />) This restri6iiol ' se Js effective beginning on /`� _and shall remain in effect "Until i <br />,. �7 - I <br />r you enter rn uqe'any City of Eugene ,park, open ce f c C ility during thi effective period of this Notice, you may be <br />;rested and el"d with criminal trespass in the second degree. <br />H <br />'Pursuant for t} pen :Space Rule R -1.0 4 you are entitled to an informal hearing to contest this Notice. A request for an <br />informal hea ri st he made in d with the Parks & Open Space Division Director ( "the Division Director ") <br />' <br />within 8 hoiirs ( lusl 9f wee of this Notice at the followittg'address:1820 Roosevelt, Blvd., Eugene, OR <br />5, "402. � i wee , <br />The.bivision:Dir shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72:hours (exc'n}ivar , " 'e-'ends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testi , m you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. Thoi 7i isioi Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />This Notice - shA0,Tem'aln 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 />A N•. S <br />t <br />(Signature of person issuing /delivering notice) <br />I hereb j ,ac o."' efpt of t ie above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green'("op}I 'File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />.F <br />