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clglabb' 12, -27z <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: q TIME: 1 / 2 <br />(� J � CASE #: � arm -�-- <br />L OCATION (PARK/OPEN SPACE): GS S� (� L,0 (t <br />Z <br />Name: ast First Mid a <br />DOB: <br />n 15,3 <br />Race/Scx: <br />Z <br />` [7 <br />U <br />Res. Address: M 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 />The basis for this Notice of Restriction of Use is that on p 3 Zy/?i , you violated Section <br />and Open Space Rules, and/or Section , 2 -f - of the Eugene Code 1971 and/or ORS <br />/ l..` ) <br />of the Park <br />To wit, you: <br />Y °SS . L£SS �KR ►a AYJ �, Aa — g o f . T r Pq 0 - fit✓ T74 g: Pstt2u_7 <br />(Description of the violation.) <br />This restriction of use is effective beginning on Q��i1( ,a nd shall remain in effect until L <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 g and time shown above by: <br />' 3 <br />(Signature ofpersossuing/delivering noti ) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person r ng t sued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />