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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: G L l <br />LOCATION (PAR) OPEN SPACE): <br />TIME: CASE <br />M <br />F- <br />Name: sSt First Middle <br />DOB� <br />Racc/Sex <br />RCM,-. Aids--- City <br />State <br />Zip <br />Res. Phone: <br />Work Phone <br />J <br />I I I ! 1,", 11 i I I I � "I'll 11 111111111 1 1111'� 1 rJ11111 li�illi�illill� 11111 11111111 111111111 iig 1111111 111111111 11 jj �� I � <br />V --) Entering in, or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on you violated Section 0 L <br />� - o - EkAl Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />V- <br />( Description of the violation.) <br />This restriction of use is effective beginning on&A7% and shall remain in effect until O)ZS\�D <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 acrd 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 ("llic Division Director") <br />within 48 hours (exclusive of'weekends) ofreccipt 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, ftorn 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 show <br />I I 1 11 1 ap C � <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- ----- - -- ------ <br />(Signature of ry/erson being issued the notice) <br />White Copy: Public Works GTvcn Copy: File Yellow Copy: Repod Copy Pink Copy: Recipient Gold Copy: Officer Appcal ncnic� Pe 04,'01 <br />