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NOTICE OF RESTRICTION OF USE <br />11 and Notice of Right to Appeal <br />DATE: O vii TIME: 'i13� CASE <br />LOCATION (PARK/OPEN SPACE): \0kS j1 1 t (0T0A I sm ST p hgX <br />F. <br />Name: Last First Middle <br />DOB: <br />- zs aar <br />Race/Sex; <br />W <br />L 15 T o ga W)WAM <br />o4 <br />W <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />61 <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 0 y ml you violated Section 1 - 5 1 1 of the Park <br />and Open Space Rules, and/or Section 4, 1 to of the Eugene Code, 1971, and/or ORS To wit, you: <br />?0S5 Esau l Coasv th 'Ekh 1� r &fw t u 6E-� Ltd Z <br />(Description of the violation.) <br />This restriction of use is effective beginning on Q S Y and shall remain in effect until �Gd 12, . <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 />� <br />(Signa a of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />,} � � 4w.pe,.o. (Signa being issued the notice) <br />White Copy: Ppblic Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />