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{ ) - 03W 2 03 . <br /> NOTICE OF RESTRICTION OF USE <br /> and Notice of Right to Appeal <br /> • <br /> DATE: /) ( D/- / TIME: / i / 471 A CASE #: ) off-' / 3 (3 / <br /> LOCATION (PARK/OPEN SPACE): 1.- ff.b A , R i tL iag 6,4RD €4 <br /> t Name: Las First Middle DOB: Race /Sex) <br /> E. e4A 16 o xi Al 1:120 <- 6 4. ��' 9.3 4.)//2 <br /> Res. Address: City ` r � �tat� Zip_ ` J Res. Phone: Work Phone: <br /> 4537 ///2 l S% 2 s i x , p7 . <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 /> Entering in or using all City of Eugene parks, open spaces or facilities. <br /> ❑ . <br /> The basis for this Notice of Restriction of Use is that on /V , you violated Section .2-4 /1 of the Park <br /> and Open Space Rules, and/or Section 1 4)'0 of the Eugene Code, 1971, and/or ORS . To wit, you: <br /> Pvs5ei3 Mai LiA4 Ai A IN Pi i <br /> • <br /> (Description of the violation.) Q �1/ p <br /> This restriction of use is effective beginning on � 7 o � , and shall remain in effect until $49 e / /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 No ' e at the dat d time shown above by: <br /> c , ( °3 <br /> (Signature of person issuing /delivering notice) <br /> I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br /> • 0 ./ o , <br /> Signature of person being issue• the notice) <br /> ✓kite Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />