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NOTICE OF RESTRICTION OF USE <br /> and Notice of Right to Appeal <br /> DATE: d TIME: / CASE #: l -' / 3 (3 1 <br /> LOCATION (PARK/OPEN SPACE): /j)/L 1 AMtfie" ,4 / fi aAgDe <br /> Name: Last First Middle DOB: Race /Sex: <br /> Res. Address: City State Zip Res. Phone: Work Phone: • <br /> 1 537 tl/2Lsar �� Ell ��Al� vk Vs <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 /> ,i_ 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 ��"�� , you violated Section �- ' of the Park <br /> 7 <br /> and Open Space Rules, and/or Section ` 4 `7O of the Eugene Code, 197i, and/or ORS . To wit, you: <br /> P0S5ES6 i M 'i../A4 it) !AI pA <br /> (Description of the violation.) <br /> • <br /> This restriction of use is effective beginning on PO 401 , and shall remain in effect until Z: � � . <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 s.�oond 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. 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 datvand time shown above by: <br /> i , <br /> (Signature of person issuing /delivering notice) <br /> I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br /> d i :. W:.- . AL/AL , / <br /> ( Signatur oe f 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 />