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NOTICE OF RESTRICTION OF USE 5 � - I;tlku iii i, I CIS I <br />DATE: l5- <br />and Notice of Right to Appeal <br />TIME. _L3 <br />CA SF <br />TCY0 <br />LOCATION (PARK�OPEN <br />I - <br />Name: Last First Middle <br />DOB: <br />R k i c e. cv <br />r <br />-IJ <br />"I A.Qf <br />03 i- -- Z-< <br />Res, Addrtss: <br />Zip <br />Res. Phnne: <br />Work Phone: <br />111111111111 1!111111 Q I IF 111 111111 <br />['I: Entering in or using all City of Eugene parks, open spaces or facilities. <br />N' <br />I / <br />This restriction of use is effective beginning on --2�9 � -7) , and shall, remain in effect until 10 % L o-7 �u <br />If you enter in or rise 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 .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: IN20 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 of 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 />- — --------- <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 />-5 <br />White Copy, Public Works GivenCopy: He Yellow CL)py! Report Copy Phik Copy Rocipicffl Gold C�,�py Officer ApNaf Douce +V�l Rm 04/03 <br />