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� 1 5V 0 \o <br />and Notice of Right to Appeal <br />3 <br />DATE: TIME: CASE #: <br />LOCATION (PARK-/OPEN SPACE):_ 0 A-K <br />l- <br />Na N [av ast First Middl <br />P-K 'T A <br />Res, Address City <br />State <br />Zip <br />-1 <br />Res, Phoney <br />Work Phone: <br />notified that you are prohibited from (check box): <br />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 —010JI-4-1 you violated Section 11—CA of the Park <br />Space Rules, and/or Section of the Eugene Code, 19"71, and/or ORS —. To wit, yo <br />(Description of the violation.) <br />This restriction of use is effective beginning on — 0 907 A and shall remain in effect until 69671X, <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 ta art <br />informal bearing 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, Cl <br />97402. <br />The~ Division Director shall schedule a time and place for the infest mal 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 <br />,,at date and time shown above by: <br />of person issuing/dclivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indica <br />r of person being issued the notice) <br />White Copy: Public Works Given Copy File Ye I low Co py : R oport Copy Pink Copyi Recipient Gold Copy; Officer Appeal notice Kev, U10 <br />