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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to .Appeal <br />DATE: OPI9 ►S TIME.: ❑-71ee CASE 4: IS -1 dlyu <br />r <br />LOCATION (PARK/OPEN SPACE):Shy+x q," /Surra <br />ti <br />Namc; Last First Middle <br />DOB: <br />Race.!Spx: <br />Res. Address: City <br />State <br />Zip <br />Res, Phnne: <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 arc hereby <br />notified that your are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on CZ i9 LS' , you violated Section I-0, IL &)of the Park <br />and Open Space. Rules, and/or Section -?, tlq of the Eugene: Code, 1971, and/or URS . To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on S , and shall remain in effect until Olgd, <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 he <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 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: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place ror 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 onlyconsider testimony frotn 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, frotn the informal hearing. <br />This Notice shall retuain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of thi0�e <br />e and time shown above by: <br />'" <br />(Signature of person issuingidulivcring 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: Recipient Gold Copy: Officer Appeal notice ke%•. 414.'113 <br />