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DATE: d I0 8 1 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />TIME: <br />NIS� Iq153� <br />CASE <br />LOCATION (PARK/OPEN SPACE):_ g -k- 10cle-S 11646 0/1-1< <br />- <br />Name: Last First Middle <br />DOB: <br />Race/Sex/ <br />z <br />WAR -b5 C'�� J ­ OF ���. <br />k c <br />631x8 <br />� F9 <br />Res. Address:- City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />+ <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 />4 Entering in or using all City of Eugene parks, open spaces or facilities. <br />[a <br />The basis for this Notice of Restriction of Use is that on 090610 , you violated Section D 10 of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS . To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on 0 9 D 91 ! , and shall remain in effect until /0 0 9/ . <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 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 a date and time shown above by: <br />#39� <br />(Signah► of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />r� <br />Sigjnaturc o1'pc:rson being; issued the notice) <br />Whilc Copy: Puhk Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Reuipicnl Gold Copy: Officer Appeal notice Rev. 04/03 <br />