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NOTICE OF RESTRICTION OF USE <br /> and Notice of Right to Appeal fi ve 1:1-66.8 / 7 <br /> DATE: `U (` /, TIME: ) `'>' I Q CASE #: G -. t 3'. k <br /> LOCATION (PARK/OPEN SPACE): J/ )J f/1 7E i2i } /i J '( 7)i <br /> Name: Last First Middle DOB: Race /Sex: 001e(31 0,7-a obli <br /> . <br /> Res. Address: City State Zip Res. Phone: Work Phone: <br /> 537 f /(LLsf7ti DDS CljrEtJ d 97 KEcla.SED <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 /> 44 notified that you are prohibited from (check box): <br /> Entering in or using all City of Eugene parks, open spaces or facilities. <br /> D <br /> •-• The basis for this Notice of Restriction of Use is that on / /R'o /' /2s. , you violated Section c. .0( of the Park <br /> (it) <br /> and Open Space Rules, and/or Section of the Eugene Code, 1971, "and/or ORS To wit, you:_ <br /> Po sr ARcJ wP 10 PRIB <br /> (Description of the violation.) (� ' <br /> This restriction of use is effective b on ')O D� ' and shall remain in effect until (it O/-/r)? <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. Q <br /> Pursuant to Park and Open Space Rule R-1.974 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 Notice at the date and time shown above by: <br /> (Al) / )®.rrn 0: <br /> (Signature of person issuing /delivering notice) . <br /> I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br /> �} <br /> RLrb s ir S'16J <br /> (Signature of person being issued the notice) <br /> White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy; Officer Appeal notice Rev. 04/03 <br />