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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: 120 CASE #: I Z'" I J I Ll <br />LOCATION (PARK/OPEN SPACE): <br />w <br />a <br />Nam : Last First Middle <br />�� 4�� h�� <br />DOB: <br />-92 <br />U 5 <br />Ra 1 ex: <br />1 4AJ/ 1 <br />� <br />Res. Address: r City <br />State <br />dip <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 />I <br />The basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />and Open Space Rules, and/or Section qv of the Eugene Code, 1971, and/or ORS To wit, you: <br />f�, �-.5A)d 4f�55_ `/0&_APJ __ 10V!!! <br />(Description of the violation.) <br />This restriction of use is effective beginning on Qts� � Z— ,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 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 N tice at the date and time shown above by: <br />ignature JT person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />nature o 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 />