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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />r w- DATE: i ell <br />_VW_ 17 TIME: f CASE . #! <br />LOCATION (PARK/OPEN SPACE)JK �75 <br />E-- <br />7 <br />Name: Last First Middle <br />P f <br />F)O& <br />Ra"' S : <br />"VI <br />0. <br />1 7 AJ7 1-10 1 <br />Res ddress,: City <br />State <br />Zip <br />Res, Phone: <br />Work Phone <br />notified that you are prohibited from (check box): <br />gpi M, <br />10,11 <br />The basis for this Notice of Restriction of Use is that on / you violated Section ofthePark <br />mid Open Space Rules, and/or Section a 101 of the Eugene Code, 1971, andYor ORS To wit, you: <br />Ac��� �f�kkl L-1 AL_YA2_z0 FMIS KCMQPI�_ AN60 <br />(Description of the violation.) <br />This restriction of use is eifective beeinuine on <br />ri in effect until qh� / 11 <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-1.074 you are entitled to an informal hearing to contest this Notice, A request for art <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("(he 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 />i i�, 21, a lure OflICTS011 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />v- o <br />(Signature of person being issued the notice) <br />White Copy: Public' orks Green Copy: File Yellow Copy! Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rcv. CW03 <br />