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l <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: f 3S � CASE #: <br />LOCATION (PARK/OPEN SPACE): .:1.. I tf I'A �� << �� �OC. f � S I 94ZO DA IBC 9r. <br />H <br />a <br />Dame: Last First - Middle <br />IA�l A 5 OF 0 4 e y 4 /jAt <br />DOB: <br />07 a;? 81 <br />Race /Sex: <br />U <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />l <br />work Phone: <br />15 6) _ Ir C(,166iV4 <br />Linder the authority of Administrative order No. 58- 03 -24 -F and Park and open Space }'tine 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 !'? lh,2s /a. ,you violated Section o7. • orr of the Park <br />and Open Space Rules, and/or Section y WZ of the Eugene Code, 1971, and/or ORS To wit, you: <br />�VIM*0WAL �2 <br />(Description of the violation.) <br />This restriction of use is effective beginning on O and shall . remain in effect until 0 . <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 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 No�'ticL at the date and time shown above by: <br />Ks <br />(Si� nature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />�jJ-4 <br />/� ��� <br />(Signature of person bein 'Sluk &qoGce) <br />White Copy: Public Works Green Copy: File 'Mellow Copy: Report Copy Fink Copy: Recipient Gold Copy: officer Appeal notice <br />Rev. 44103 <br />