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NOTICE OF RESTRICTION OF USE T <br />and Notice of Right to Appeal <br />DATF. TIME: CASE #: AA <br />LOCATION (PARKjOPEN SPACE): 3 <br />t. <br />N ame� Last Fir.q Middle <br />N Aj <br />DOB: <br />0 2) `6 <br />Rac- <br />Q1, <br />&J (I <br />t <br />CZ <br />Res. AddrFS: city <br />State <br />Zip <br />Res, Phone: <br />Work Phone: <br />notified that you are prohibited from (clieck box). <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis ror this Notice of Restriction of Use is that on 0LDV,yo-u violated Section I + (J�4��)the Park <br />If you enter in or use any City of Eugene park, open space or facility during the effective period (if this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pun cant to Park and Open Space Rule R-1.0 you are entitled to an informal hearing to contest this Notice. A request for an <br />infix al hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division DirectGr­) <br />within 4 9 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., E ugene, 0 R <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which %hall 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 (if this Notice at the date and time shown above by: <br />1 �;;� ---- — ---- - <br />(Signature of person lssiung/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />1� <br />-- --------------- . .... - --------- - -- (Signature of person being issued the notice) <br />White Ccpy� Public Wurks Givoi Copy Rc Y61ow Copy Rizpun C ti ipy Pink Copy: Rwpwnt G,�] d Copy: 0 Meer A ppeal notice R0,2,041,01 <br />