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1 - 75_l &Z f o g 0 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: � !� /� TIME: CASE #: ti - - 2 - 1 y - <br />LOCATION (PARK/OPEN SPACE): <br />z <br />W <br />Name: Last First Middle <br />I.& �.�t� DV t�n(e <br />Vin! � <br />DOB: <br />9 ' 26 <br />Race /Sex: <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />WY2rk Phone: <br />pt" S ir",*- L�i/�tVV • <br />- <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-isipg all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section " I I of the Eugene Code, 1971, and/or ORS To wit, you: <br />;V r'- j, t"i Pis [jsS,a✓ ar- I V rrA., i?(17- E <br />r - <br />1"c) (V a al° &..rEe) <br />(Description of the violation.) <br />This restriction of use is effective beginning on L "Z " !! , and shall remain in effect until f- Z o I'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 and time shown above by: <br />lir 6r -c' <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(SignatiVeWperson ein ss a eno e) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />