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DATE: 0? (25' /� <br />NOTICE OF RESTRICTION OF USE <br />and. Notice of Right to Appeal <br />TIME: / � o r <br />LOCATION (PARK/OPEN SPACE): )�b_ st <br />a <br />CASE #: ) !;--I 1 -3 "-// <br />N <br />"' <br />Name` Last Fust Middle <br />Ar <br />yDOB: (� <br />Race/Sex: <br />c.. <br />/ i ire e—)�( <br />U <br />Res. Address: city <br />State <br />Zi <br />Res. Phone: <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 />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />© j0 <br />The basis for this Notice of Restriction of Use is that on _ , you violated Section <br />7 4 <br />and Open Space Rules, and/or Section �• "`: of the Eugene Code, 1971, and/or ORS <br />(Description of the violation.) �)/ t "1 01( Crr�c­,r <br />This restriction of use is effective beginning on � 0�7� , and shall remain in effect until <br />f ` 0 l of the Park <br />To wit, you: <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 an <br />infiormal 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 receipl 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 date anti time shown above by: <br />,ate'"-."�'r'�✓ � f � �� <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 Green Copy: File Yellow Copy: Rrport Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev- 04.413 <br />