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b I � <br />l�L <br />NOTICE OF RE s OF USE <br />and Notice of Right to Appeal <br />D <br />DATE. Q <br />TIME: 1 77 0 <br />CASE #: <br />LOCATION (PARK/0PEN SPACE): <br />bi,5�k I T-2-Fe' CVI( <br />4 <br />Name: [,.ast First Middle <br />DOB <br />Race/Sex; I <br />Res. Ad city <br />State <br />zip <br />Res. Phone: <br />Work phone� <br />Under the authority olAdministrative 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 />,90 Entering in or using all City of Eugene parks, open spaces or facilities. <br />F1 <br />This restriction of use is effective beginning on (3 1 I S and shall remain in effect until <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 Et -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 fol address: 1820 Roosevelt, B1 vd., E ugene, 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) ofteccipt oFthe 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 bye <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 />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copv! Rec i p wnt Cold Copy! Officer Appeal nonce Rev. 04.103 <br />