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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: bq D afTIME: 10i 1� 4 2 CASE # <br />LOCATION (PARK/OPEN SPACE): Maptlur, Sri &A -k <br />5N5�1,1eu014 <br />T� 3 <br />— <br />Name:: Last First Middle <br />DOB: <br />itaceiSex: <br />Rcs. Address: City <br />State <br />Zip <br />Res. Phone: <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 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 />❑■ <br />The basis for this Notice of Restriction of Use is that on tee) q, 6 q S you violated Section r I d of the Park <br />and Open Space Rules, and/or Section IqO of the Eugene Code, 1971, and/or DRS . To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on 061 0 qi 5'- , and shall remain in effect until «6 1-1 1 S <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 SIR 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 f'or 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 at t Ldmeand time shown above by: <br />it 3 Is - <br />(Signature _persotl issuing/delivering notice.) <br />I hereby acknowledge rcecipt of the above Notice on the date and time indicated above. <br />(Signature of person being issue the notice;) <br />White Copy Public Works Green Copy file ti'ellow Copy: Report Copy fink Copy: Recipient Gold Copy: Officer Appeal notice Rev- 04 11] <br />