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T317 "C7E '12t F X Tj 7S <br />and Notice of Right to Appeal <br />M <br />LOCATION (PARK/OPEN SPACE): <br />TIME: <br />BLOC <br />4:�g45 \5r -, I LAt� <br />CASE #: S U <br />do <br />G. <br />Naine: Last r First di <br />GAO (L M <br />DOB: <br />1 <br />R Is <br />W <br />es� <br />I <br />Res, ress� City <br />stag <br />zip <br />�ne� <br />Work Phone: <br />notified that you are prohibited from (check box): <br />lik Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on. you violated Section o,,f the Park <br />14 <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, andfor ORS �1 " �- To wit, you:_, <br />AA <br />(Description of the violation.) <br />This restriction of use is effective beginning on 04-215---&'ant) shall remain in effect until <br />If you enter in or use any City of Eu gene 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 rquest for an <br />Ti unn 46 Nun rs t excl Isive 71 weexcitus) or receipt 7 1 MM i ULILU IV iM rUWYffg: VrM, 2 , j � <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 (if weekends) of receipt of the request for hearing. At the inibrmal 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 />M <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 />Whitc Copy: Public Works Cheers COPY! File Yel low Copy: Rcporl C opy Pink Copy: Recipienr Gol Copy. 0 fficer A ppta I notice Rcv 04/03 <br />