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• <br /> NOTICE OF RESTRICTION OF USE and Notice of Right to Appeal 11) C /.7%-,66‹? /7 <br /> DATE: Q U Q' t r`-/ TIME: I7 ad CASE' #: (2 ( 31 % <br /> LOCATION (PARK/OPEN SPACE): C f l ( " 4 f 77 R 1 Ugg (91/tP / a e (�,L,v <br /> Name: Last First Middle DOB: Rac S x: <br /> R4 Address: City State Zi Res. Phone: Work Phone: <br /> ti ,7) DiS glicE as 97 RCCU,Seb <br /> Under the 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 /> K., Entering in or using all City of Eugene parks, open spaces or facilities. <br /> 0 . <br /> The basis for this Notice of Restriction of Use is that on 10 -/A , you violated Section l g of the Park <br /> and Open Space Rules, and/or Section df ` e t gene Code, 1971, and/or ORS . To wit, you: <br /> Po sss� uuA -,�Pr 10 PiRK <br /> (Description of the violation.) <br /> This restriction of use is effective beginning on 1) J v 1 ' N � , and shall remain in effect until 0L 0 f - / 2 . <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: 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 N . ce at the date and time shown above by: <br /> (Signature of person issuing/delivering notice) <br /> I herei"- :.)t of the above Notice on the date and time indicated above. <br /> -'. - - . -' . \ qfri.1 /g5 g/6 <br /> :; n (Signature of person being issued the notice) <br /> �. r <br /> he _ <br /> t <n Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy Officer Appeal notice Rev. 04/03 <br /> Mr: <br />