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ANS I eitiA <br />'.NOTICE OF RESTRICTION OF USE <br />and Notice of Right. to Appeal <br />DATE-. c 1 60� �� TIME,: CASE <br />LOCATION (PARK/OPEN SPACE): y"r,—y 0,(2. (C <br />W <br />0. <br />Name. ast First Middle. <br />DOI3: <br />RacelScx: <br />L <br />Res. nddre City <br />State <br />Zip <br />Res. Phon : <br />Werk 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 />The basis for this Notice of Restriction of Use is that on Qcl CM v b <br />and Open Space Rules, and/or Section <br />�r2k r <br />(Description of the violation.) <br />you violated Section ! i Uwt kq"of the Park <br />of the Fugene Code, 1971, and/or ORS . To wit, you: <br />j 4 � <br />This restriction of use is effective beginning on Q ci:�Cl IS and shall remain in effect until dq C) � l 6 <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 at the date and t me shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />0 <br />(Signature of person being issued the notice) <br />White Copy: Public Works 6reen Copy: File Yellow Copy: Repan Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev- 04,'03 <br />