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[ 9 [It � �. <br />q �07 _;L <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: (t) TIME: CASE <br />LOCATION (PARK /OPEN SPACE): �� 3Z- h1O <br />a <br />Name: Last First Middle <br />i AtJ L <br />DOB: <br />i <br />Race/Se Jj <br />U <br />W <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />Under the authority ofAdministrative OrderNo. 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 �{ LZ you violated Section 1. 1. e 1 of the Park <br />and Open Space Rules, and /or Section of the Eugene Code, 1971 and/or ORS To wit, you:_ <br />` _CU"6 ;I� t �Ptdul� <br />(Description of the violation.) <br />This restriction of use is effective beginning on IZ , and shall remain in effect until G � <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 ofweekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />?.97402. <br />-- I <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 he date and time shown above by: <br />ignature ofperson issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. ; <br />(Signature. of person being issued the notice) <br />i <br />{ <br />s. <br />6y:Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipieot Gold Copy: Officer Appeal notice Rev. 04 <br />x' <br />t <br />