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NOTICE OF RESTRICTION OF USE <br />J, and :Notice of Right to Appeal <br />DATE:E: T <br />- _ 11�I �M CASE <br />LOCATION (PARK/OPEN SPACE):_ f ptrw <br />r <br />Name: La.,, First M ale <br />DOB: <br />Racelscx: <br />t <br />Zj <br />x <br />Res. Add;,ess: C'i!yStale <br />Gip <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 />0-1 Entering in or using all City of Eugene parks, open spaces or facilities. <br />Fl <br />The basis for this Notice of Restriction of Use is that on 7Ct 5'C S� ,you violated Section t ,p j 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 />l �. <br />This restriction of use is effective beginning on �1 t,� , <br />and shall remain in effect until r""`Y <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. �1� <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 />izicident, 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 bearing, <br />This Notice of Exclusion was delivered to the person named at the top of this Notice t the date and time shown above by: <br />(SigNture?pson issuingldellvering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: Public Works Grein Copy: File Yellow Copy; Report Copy Pink Copy: Recipient Cold Copy: Officer Appeal notice Rev- 04.'03 <br />