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NOTICE OF RESTRICTION OF USE <br /> c �� - (0 <br /> and Notice of Right to Appeal 1i� /7 <br /> DATE: g` L/ IcC TIME I "ir CASE #: ( ` f 3 ` <br /> LOCATION (PARK/OPEN SPACE): t'/ )Jz I> n 111 �/.rJE� /�)!,)Fii g . r <br /> .. Name: Last First � , Middle DOB: Race /Sex: Ai ha 0. A e <br /> F. <br /> Res. Address: , State Zip Res. Phone: Work Phone: ,_ . <br /> 4537 1111",51 D 116EAE 97 q0z. -5E-h <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 /> , 0 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 r/) ''V1' ! g , you violated Section 02.0t 9 of the Park <br /> and Open Space Rules, and/or Section '�f. �+"ri� th Eugene Code, 1971, and/or ORS . To wit, you <br /> • <br /> • <br /> P s5.= - Ss MARLIOA JP tp1 PfiRK <br /> (Description of the violation.) pp " ``!� n <br /> This restriction of use is effective beginning on / Pt it and shall remain in effect until �.�9 ONO? . <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 /> • <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 Notice at the date and time shown above by <br /> CA)0.1.011.41) • / <br /> (Signature of person issuing/delivering notice) . <br /> • <br /> I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br /> REF14 l 161 <br /> (Signature of person being issued the notice) • <br /> • <br /> • <br /> White Co Public Works Green Co File Yellow Co Report Co Pink Co Recipient Gold Co Officer Appeal notice Rev. 04/03 <br /> Copy: Copy: Copy: P Copy Copy: P Copy: PPe <br />