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NOTICE 1 -70 <br />F RESTRICT N OF USE �7 <br />and Notice of Right to Appeal <br />DATE: 0 6 TIME: CASE #: <br />LOCATION (PARK/OPEN SPACE): Rd-d 0i: <br />z <br />Name: ast F' 3vli le <br />DOB: <br />Rac /Se <br />o <br />�� <br />� <br />* e <br />!N <br />0 <br />e . ddre s: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />U rk <br />A7 `e'' f <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 />Ix 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 b ')Z( It , you violated Section of the Park <br />and Ofe l Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS � wit, you: <br />(Description of the violation.) <br />j This restriction of use is effective beginning on o`�l a , and shall remain in effect until c�a� <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 testiire M, "from the informal hearing. <br />This Notice shall remain in effect pending an `equested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice the date and time shown above by: <br />3 <br />(Si a e of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicate ove. <br />Qi'� 41 r <br />� <br />a (Sig re o perso F u issued 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 />