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-11,0ka V t" <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal o� J 1 14 <br />-DATE: TIME: 0 I [ *I CASE p #�1r, 11 ° t O 3 C3 9 <br />LOCATION (PARK/OPEN SPACE): W A5141AI6TU, J C F EC erc t 1'4c C <br />F <br />Name: Last First Middle <br />DOB: <br />Race/Sex- <br />t ?z_� & W,, JZ!Ys4.A/ <br />631 <br />Res. Address: City <br />1 <br />State <br />1 <br />Zip <br />Res. Phone: <br />Work Phone: <br />F�v i <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 using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on i Z l ) t I you violated Section (J/ of the Park <br />and Open Space Rules, and/or Section 1 r 0 of the Eugene Code, 1971, and/or ORS To wit, you: <br />t`:X'r26/1C 6"GA(nF Aaw-JD PALE - 49 76W7 L Nctom'/ 7t0 14_ff(ZAeT f41 <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until QZ f 1 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 No ce at the date and time shown above by: <br />WO& <br />(Signature of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated ab <br />L. - <br />(Signature of person i g issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />