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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 071 bZAl <br />LOCATION (PARK/OPEN SPACE): <br />r Name: Las` A L i �osSY <br />ZW U Res. Address: <br />TIME: f 30 ' '` 1 "' / #: <br />First Middle �3`oN �aaie <br />State Zip <br />C 0 q t it y f oR <br />g 10 Oi4K <br />DOB: <br />042iG5 <br />Res. Phone: <br />1 2 - 1 B <br />Race /Se <br />� I W? <br />Work Phone: <br />/ 6 -efl <br />Under the authority of Administrative order No. 58 -03 -244 and Park and open Space Rule R- 1.005(3) you are hereby <br />notified that you are prohibited from (check box): <br />In - Entering in or- using all City of Eugene parks, open spaces or facilities. <br />D <br />The basis for this Notice of Restriction of Use is that on ��12 you violated Section I • 0 7 d of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />Vlt���ttu� F � .k ��RK RU e L I TT� N� <br />(Description of the violation.) <br />(��� 2ojZ shall remain in effect until 071 b Z01.3 <br />This restriction of use is effective beginning on <br />a p en Eugene of Eu ark o space or facility during the effective period of this Notice, you may be <br />If you enter in or use any City g p p <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and open Sp Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A request for an <br />writing and filed with the Parks & open Space Division Director ( "the Division Director ") <br />informal hearing must be made �n g <br />} p <br />Within 48 hours (exclusive of weekends of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, DR <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 a he ate and time shown above by: <br />L/ <br />( gnature of person issuing /delivering notice) <br />i <br />above Notice on the date and time indicated above. <br />I hereby acknowledge receipt of the <br />01 <br />(Signature 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 <br />t <br />Rev. 04103 <br />r <br />