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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: rj \ CASE #: <br />LOCATION (PARKjOPEN SPACE): <br />IY2 (( <br />-Arb <br />z <br />Na frost Fit Middle <br />1)013� <br />Race,'Sex: <br />Kes. Address: city <br />State <br />Zip <br />Res, Mime: <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />notiried that you are prohibited from (check box): <br />F -D Entering in or using all City of Engene parks, open spaces or faciliti67 <br />This restriction of use is effective beginning on ind shall remain in effect until <br />AC3A � I <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 />flu rsuant to park and Open Space Rule R- I , 074 YOU are entitled to an informal hearing to contest this Notice. A request for aTi <br />informal heating must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive ofwcekends) (if 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 N-ofice 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 />- - - - - ----- ------------------ <br />(Signature of person issui& notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />N <br />(Signature of person being issued the notice) <br />What Copy: Pubhc Worb Green Copy; He Yellow Copy, Report Copy Pink Copy! Recipient Gold Copy: Offikxr Appcal notice <br />Rev. 04.'01 <br />