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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: C)I I TIME: -� 1 '7 CASE #: I J' 2�1 <br />LOCATION (PARK/OPEN SPACI-i): W r� � �I�� J-� W , �J <br />a <br />Nam ast First ldd <br />RaceiScx <br />ate dress: Cit <br />i 5 ► -- z <br />ate <br />i <br />F)�40 <br />L <br />Re. P ne: Work 'hone: <br />Nb . -' i <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 />AW-,�c <br />The basis for this Notice of Restriction of Use is that on ' you violated Sectiont <br />� ffJJ <br />and 0lyn Space Rules, a )4/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 9D/ -y/ -)0' -and shall remain in effect until d <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 arc entitled to an informal hearing, to contest. this Notice. A request for an <br />informal hearing roust 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 />47402. <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 wilt 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 />I'his Notice shall retrain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this tice time shown above by: <br />(Signature ofperson issuing/delivering notice) <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />7 <br />(Signatu fperson being issued the notice) <br />L <br />While Copy: Public Works Green Copy: File Yellow Copy! Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. MiW <br />