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NOTICE OF RESTRICTION OF USE <br /> and Notice of Right to Appeal <br /> DATE: T "I' TIME: CASE #: "" ' <br /> LOCATION (PARK/OPEN SPACE): Lt,..) P, : L t t : ; s.a. J C: . <br /> H Name: t , y t gw First . ,,Middle + DQB: Race /Sex: <br /> f ". d c,„E � J j 'i �..t ,. i ...J tsr3 (.i..✓ �'�-� <br /> Res. Address: City State Zip Res. P Work Phone: <br /> i f.✓ {i/ ,,. ' xq f i t Al/ 1 <br /> Under the authority of Administrative Order No. 58- 03 -24 -F } and Park and Open -Space -Rule R- Loos(3), you are heieby <br /> notified that you are prohibited from (check box): <br /> Entering in or using all City of Eugene parks, open spaces or facilities. <br /> 0 <br /> The basis for this Notice oftRestriction of Use is that on 1 d .. , you violated Section /lib l of the Park <br /> and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS 1 4 7 e . Li. To wit, you: <br /> t....,i " i � ` t 4 6 lr 1 " . k F T t , } d. E r k p__I t r # </ t +r _I yf " d <br /> (Description of the violation) <br /> r f f. <br /> This restriction of use is effective beginning on " " , and shall remain in effect ull f- " • <br /> If you enter in or use any City of Eugene park, open space or fcility 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 Notice at the date and time shown above by: <br /> (Signature of person issuing /delivering notice) <br /> I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br /> (Signature of person being issued the notice) <br /> Rev 04/03 <br /> White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice . <br />