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/ <br />NOTICE OF RESTRICTION OF USE � <br />and Notice of Right to Appeal <br />1:5 <br />DATE: °' TIlVIE: ' a CASE #: �- <br />LOCATION (PARK/OPEN SPACE): <br />Name: t FiAl fiddle DDB: Race /Sex: <br />a G oo d y <br />Res. A City State Zip Res. Phone: Work Phone: <br />Under the authority of Administrative order No. 58- 03 -24 -F and Park and open Space Rule -1. 05(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 ou violated Section �] of the <br />y Park <br />and en Space Rules and/or Section f of the Eugene • <br />p p ge e Code, l 97 I , and/or DRS To wit, you. <br />I <br />(Description of the violation.) <br />This restriction of use is effective beginning on °� �>�- -, and shall remain in effect until <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 />M10 <br />(Signature of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Si afore of 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 />