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NOTICE OFRESTRICTION OF USE <br />a n d N ofice of Right to Appeal <br />DATE: TIME: -r- 3-�fpn CASE ft: <br />A <br />LOCATION (PA /OPEN SPACE)!1-�Jp��e�j_ <br />7 <br />rne Last First Middle <br />D B <br />ry) <br />Res. Address: city <br />State <br />Zip <br />It's Reg. Phone: <br />Woir* phonl.�; <br />It on, <br />I OWN <br />X Entering in or using all City of Eugene parks, open spaces or facilities, <br />ON <br />`The basis for this Notice of Restriction of Use is that on you violated Section - 0 X , f the Park <br />Lj1— _9 <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS --, To wit, you: l6l kc- <br />( D e se ription o F th c violation. 1 � <br />This restriction ofuse Is effective beginning on 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 R- 1.0`74 you are entitled to an informal hearing to contes't this Notice. A request for' <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Directole') <br />within 49 hours (MILI[SiVC 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 ol "weekends) of receipt 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 info at 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 dale and time shown above by: <br />-------- <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 />While Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy! Recipient Gold Copy: Offiecr ,oil l notice Rev. 04/M <br />