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NOTICE OF RESTRICTION OF USE 40260( <br />and Notice of Right to Appeal <br />DATE: � �� �' J L TIME: � °� tl 0 3 A L CASE #: <br />LOCATION (PARKJOPEN SPACE): 4 <br />, 4:0 z Name: ast first iddie <br />ALf W Al 7 E & — A l � <br />Iii <br />Res. A ss: City State Zi <br />'e <br />DOB: <br />��lg -7 t <br />Res. Phone: <br />Race1S x: <br />k) /If <br />Work Phone: <br />Under the authority of Administrative order No. 58- 03 -24 -F and Park and Open Space Rule R4.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />r Entering in or using all City of Eugene parks, open spaces or facilities. <br />a V11PW IF <br />The basis for this Notice of Restriction of Use is that on �� g" /� you violated Section of the Park <br />and Open Space Rules, and/or Section • 0 of the Eugene Code, 1971, and/or ORS To wit, you: 0ma' <br />A tAJ _162 A00_44v A) Al A <br />(Description of the violation.) <br />This restriction of use is effective beginning on '" ; and shall remain in effect until �°'/f <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 />)7402. <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 />,neident. The Division Director may exclude anyone, other than you and those . <br />presenting testimony, from the informal hearin g <br />Chis Notice shall remain in effect pending any requested hearing. <br />Chis Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />jD <br />(Signature of person issuing /delivering notice) <br />;hereby acknowledge receipt of the above Notice on the date and time i icated b e. <br />L <br />Fatui�e of person being issued the notice) <br />opy: Public Wor Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />