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NOTI E OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: Q lX j,5 / C2, <br />LOCATION (PARK/OPEN SPACE): <br />TIME: 17(&" <br />8 a-� 4 37_ <br />0.5`3 7Ds <br />CASE#: �— r�47rs <br />F <br />Name: Last First Middle <br />.-� - <br />DOB: <br />� <br />ID F <br />Race /Sex: <br />W <br />U <br />Res. Address: City State Zip <br />Res. Phone: <br />work Phone: <br />&A/T <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 />I'$- 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 Q� 215 � � _ ,you violated Section of the Park <br />.r <br />and Open Space Rules, and/or Section L'� � ' of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on � & � off, and shall remain in effect until o &2 ✓� 13 <br />If you enter in. or use any City of Eugene park, open space or facility during the effective petiod 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 z Notic at the date and time shown above by: <br />... ........ O-PeA 4- _-, -44 3 5�r <br />tore of person issuing /delivering notice) <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />ite Copy: Public works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04143 <br />