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DATE: <br />NOTICE OF RESTRICTION OF USE *wO I C'V I <br />and Notice of Right to Appeal <br />TIME: JFK.? CASE#: <br />LOCATION (PARK/OPEN SPACE): 4l S Bhr x— <br />1-S r- 1 V.) 767 n4 <br />r <br />Name: Last First Middle <br />DA7/q.2 <br />Itacc +''S <br />y <br />i2AVI)JTEA/ C 9 1 it) L/ <br />Res. Address: City <br />Stale Zip <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 />l/ Entering in or using all City of Eugene parks, open spaces or facilities. <br />❑■ <br />The basis for this Notice of Restriction of Use is that on , you violated Section ei is o <br />Ile Park <br />and Open Space Rules, and/or Section _A IRP of the Eugene Code, 1971, and/or URS To wit, you: <br />(Description of the violation.) y� <br />This restriction of use is effective begg innin on G ��i �,�and shall remain in effect until <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 be made in writing anti filed with the Parks & Open Spice Division Director ("the 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 atke d ar�rYfime shown above by: <br />(5i ofperson issuing/dclivcring 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 Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Rccipient Gold Copy: Officer Appeal notice Rev. 04'03 <br />