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No,nCE OF .RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: /0)0 CASF, <br />LOCATION (PARK/OPEN SPACE): *--,J eq !;�&_ /&t <br />�. <br />Nal l.atit F'AV>Vlidiil�. <br />I){fli: <br />w <br />�„� & <br />2 <br />� I <br />W <br />Res dress City <br />State <br />Zip <br />Res. Phunc: <br />NVork Phone: <br />j <br />�1 <br />tinder the authority of Administrative Order No. 58-03-24-F and Park and Open Spare Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />AEntering 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 , you violated Section D of the Park <br />a1pud Open Space Rul •s and/or Section ) of the Eugene Code., 1971, and/or ORS To wit, you: <br />14/J/,Z7,( Ve� AMC ka C -A <br />(Description of the violation.) <br />This restriction of use is effective beginning on ko ?'a?j��,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 and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 49 hours (exclusive o-l'weckends) 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 inforrlial 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 Nice at t nd h shown above by: <br />3 55' <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the. above Notice on the date and time indic6Sgnatu- <br />` <br />ol�person ng issued the notice) <br />White Copy? Public Works Green Copy. File Yellow Copy: Report Copy Pink Copy' Recipient Cold Copy: 0fcer Appeal notice Rev. 041W <br />