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NOTICE OF RESTRICTION OF USE <br />C -5og <br />and Notice of Right to Appeal ' f <br />DATE: 047 TIME: /3S6 CASE #: �.S►r��v�'1 <br />LOCATION (PARK/OPEN SPACE): C3,ff4,/ e�4 <br />r <br />Name: Last First Middle <br />DUH: <br />Race./Sex: <br />:J <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />Under the authority of Administrative Order ilio. 58-03-24-F and Park and Open Space Rule R-1.[105(3), you are herein <br />notified that you are prohibited from (check box); <br />K 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 d$ I'f /s , you violated Section of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ❑RS To wit, you: <br />f- -7"344 QE.,.e, <br />(Description of the violation.) <br />This restriction of use is effective beginning on Gf �g"1S , and shall remain in effect until 0-45/CO(c <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 />informal hearing must he made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1810 Roosevelt, Blvd., Eugene, OR <br />97401. <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 atthe 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 />White ropy: Public Warks Grccn Copy: Filc Yellow Copy: Report Copy Pink Copy Rccipielit 6old Copy: Ufliccr Appcal notice Rev. 04103 <br />