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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal 4,P-%,0 i,�to 50w7 <br />)ATE: ��� �= TIME: p �- CASE #: <br />eLf 2 <br />,OCATION (PARK/OPEN SPACE): <br />H Name: L First Mi le DOB: Race /Sex: <br />4 v I 2J24 <br />U <br />Re ess: City State Zip Res. Phone: Work Ph <br />7 0 <br />e: <br />Jnder the authority of Administrative order No. 58- 03 -24 -F and Park and open Space Rule R.- 1.005(3), you are hereby <br />iotif ed that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />ter)I <br />''he basis for this Notice of Restriction of Use is that on <br />you violated Section of the Park <br />end Open Space R s, and/or Section. of the Eugene Code, 1971, and/or ORS To wit, you: <br />Description of the violation.) <br />Phis restriction of use is effective beginning on 0 6 C6 and shall remain in effect until <br />f 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 />'ursuant 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 />nformal 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 />17402. <br />[he Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />1 2 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />onsider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />ncident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />[his Notice shall remain in effect pending any requested hearing. <br />Phis Notice of Exclusion was delivered to the person named at the top of this Notic d and time shown above by: <br />J <br />(Signatu 1 9Vof person issuing /delivering notice) <br />hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />o Public Works Green Co File Yellow Co Report Co Pink Copy: Recipient Gold Co officer Appeal notice Rev, 04143 <br />l�Y� PY� PY= P PY PY� P PY� PP <br />