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I��zac7 e - altos <br />NOTICE F RESTRICTION OF USE C <br />M and Notice of Ri�ght to Appeal / � 4 a 9 3 2 r <br />V <br />DATE: J I TIME: 1, <br />(,U CASE <br />LOCATION (PARK/OPEN SPACE): A DA/ 1 -5 T� al—k <br />W <br />N4: <br />Last / ' st , J M' <br />G. A-N 6 C <br />DOB: � � � <br />t z <br />Race/S <br />w /, - <br />d e City <br />g t`C�2 <br />late <br />Zip <br />Re . hone: t 2 7� <br />- <br />Work Ph ne: <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 you violated Section V 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 />(- This restriction of use is effective beginning on 1 1 , and shall remain in effect until. <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 Noti at the date and time s own above by: <br />/lA -9-1 # 5 5 r <br />of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated a ov . <br />(Signature of person being issued & 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 />