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NOTICE OF RESTRICTION /// ON OF USE 65-11q <br />and Notice of Right to Appeal <br />DATE: TIME: Q I � � 0 CASE / SE #: <br />L')CATION (PARK/OPEN SPACE): lVa Bid lxfV� l proo SPAez /IM Dilr` WOW ;f/\ <br />z <br />a <br />Nam a L ast 1 VIA A fIM}ddle <br />J° <br />Qo t � <br />Ra. cy�Sex: <br />Res. Address: city <br />Statg <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 />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 of the Park <br />y.�90 <br />and Open Space Rules, and/or Section k� _ of the Eugene Code, 1971, and/or ORS To wit, you: <br />G E 1 �A ld i- 11LB 5 1tiy P1 70' WX &A �XCLu31�'� �Nl� 610 M'N)Ntz OF AWOL <br />(Description of the violation.) <br />C .0 t This restriction of use is effective beginning on tJ1 j1 and shall remain in effect un o � 67 you enter in or use any City of Eugene park, open space or facility during the effective period 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 />96 *1 r r z l <br />(SignWke of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />r <br />(Signatur f person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />