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�i- �,IIl6 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE #: <br />t7�t J <br />LOCATION (PARKJOPEN SPACE): a 6 6 a A W Tr te A It <br />H <br />Name: Last First Middle <br />DDB: <br />Race /Sex: <br />AA A 0,. -r -r _m64 u T 17 Aor Aooe <br />AVI ;R <br />(A ) /A <br />V <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />_j <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 />aL7l Entering in or using all City of Eugene parrs, open spaces or facilities. <br />❑E <br />The basis for this Notice of Restriction of Use is that on 1 * 2 ' �i ' "��, p� you violated Section G 10 of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS ��. a b/D To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on 1 /0 1 , and shall remain in effect until 0/ Ir - ` 3 A . <br />+ 1 <br />If you enter in or use any City of Eugene park, open sce or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the sand 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 filed with the Parks & Open Space Division Director ( "the Division Director") <br />within 48 hours (exclusive of weekends) dreceipt 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 />(Signature of person issuing /delivering notice) <br />I - hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />i <br />Si nature of person being <br />( issued the notice) g p g <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice t Rev. 04103 <br />} <br />