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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal r� <br />DATE: ��v�-��1 S TIME: G p CASE it: <br />LOCATION (PARK/OPEN SPACE): � J _ PAkk ALCUU <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 />X <br />The basis For this Notice of Restriction of Use is that on th-7/ /: , you violated Section 1 . DPW of the Park <br />I - <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS W75 SO . To wit, you:_I.,-' 6i?,C <br />5nro �cz ► x� <br />Q-7;( Pftm k, <br />(Description of the violation.) <br />This restriction of use is effective beginning on 1 , and shall remain in effect until 9L -1711i J <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 />arTested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R-1.474 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 oI'weekends) of receipt of this Nodcc at the Following address: 1820 Roosevelt, Blvd., Fugen e, 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 infonnal 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 the ate and time shown above by: <br />"cok /� 6 -3 - <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 Fiie Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rcv- 014103 <br />Name: Last FirstMiddle <br />DOB: Racci <br />