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DATE: 9, q -t5 <br />LOCATION (PARKIOPEN SPACE) <br />NOTICE: OF RESTRICTION OF USE <br />and Notice of Might to Appeal <br />TIME: ws, <br />ft v" J p C JZ MZ►L <br />CASK #: i5-- 15661 <br />�_ <br />Name: Last First Middle <br />DOB: <br />Race/Sex: <br />a <br />A, 23-1 <br />t1iY" 1 <br />a <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />finder the authority of Administrativ=e Order No, 58-03-24-F and Park and Open Space Rule R-1.005(3)1 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 />The basis for this Notice of Restriction of Use <br />is la " `Y you violated Section <br />C] Q <br />and Open Space Rules, and/or Section Z, oil u of the Eugene Code, 1971, and/or ORS <br />aL477'ti-1� �uL� % op&J 4v`►'Rr.�L <br />of the Park <br />To wit, you: <br />(;Description of the violation.) <br />This restriction of use is effective beginning on y` ] , 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 />intormal 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, 0R <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 hcaring 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 dclivcred to the person named at the top oFthi3Noficurat the datendtime shown above by: <br />e ol'pexson issuing/delivering notice} <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />Gt [ (Am to <br />gnature of person being issued the notice.) <br />White Copy: Public Works Green Copy: Fisc Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04!03 <br />