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IS 032-0 t <br />NOTICE OF RESTRICTION OF USE _U <br />and Notice of Right to Appeal l- D7 $ S &Q <br />f DATE: �� �' g- �, TIME: - 3 o� `C / CASE M I r— 1 &/ <br />LOCATION (PARKIOPEN SPACE): 226 Q 4} (C. 61, <br />F <br />Name: Last First Middle <br />D p / <br />Race /Sex: <br />a <br />Pl t ,/�� <br />Loy f�2 l 1 <br />liv <br />Res. Address: C <br />State <br />Zi <br />Res. Phone: <br />Work Phone: <br />64 <br />OR <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 />4 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 V `oq ( ( , you violated Section of the Park <br />and <br />`` Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS ' 71 To wit, you: <br />U"� , 6a, O r' it U Fz a-1 (11c e a A �d <br />(Description of the violation.) + <br />This restriction of use is effective beginning on d�( l l , and shall remain in effect until joZo2 I Z� <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 a date and time shown above by: <br />C I& 3 � '115 <br />person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time <br />J <br />(1 tore of rs eing 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 />