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�1�0 4V1"I <br />NOTICE OF RESTRICTION OF USE <br />l and Notice of Right to Appeal <br />i <br />DATE: / TIME: /�/ CASE #: <br />LOCATION (PARK/OPEN SPACE): . . 3 C 6 & k 1r— <br />w <br />Name: L F/IIO✓t� <br />o r <br />Dy: 2. <br />Race Se <br />r <br />Res. ess: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <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 />Gk— Entering in or using all City of Eugene parks, open spaces or facilities. <br />u <br />The basis for this Notice of Restriction of Use is that on / /2/ Lr you violated Section of the Park <br />the Open Space Rules, and/or Section �J of / he Eugene Code, 1971, and/or ORS d To wit, you: <br />/ /YrG/t A6T.J6 �PGSr'�Z <br />(Description of the violation.) / °� q <br />This restriction of use is effective beginning on and shall remain in effect until / `L/ <br />r <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 />1 a <br />(Sig person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicate above. <br />c <br />(Signa of per n b issued the notice) <br />White Copy: Public Works Grem Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />