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NOTICE OF RESTRICTION OF USE 6 1� <br />and Notice of Right to Appeal <br />DATE: 0 X ®� TIME: / ° 0 5 2. A 1 CASE #: 2'_ 131Z.5 <br />LOCATION (PARK/OPEN SPACE): 5`t A R K g W G "6 <br />z <br />Name: Las <br />First <br />iddle <br />DOB: <br />Race/"-- <br />a <br />l6 N cws <br />2 <br />G,.) E <br />Res. Address: <br />5 G <br />City <br />State <br />We <br />tYb ' r <br />Res. Phone: <br />LO� <br />Work Phone: <br />�.. <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 />X 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 �(7 �� � � , you violated Section of the Park <br />and Open Space Rules, and/or Section �' / 1 of the Eugene Code, 1971, and/or ORS To wit, you: <br />Sys NSI44► wl� Z -vZ- 21 1 �2 5 4 <br />N �z �, � rr�fa v (4 �z 1 1's; 7 A� � <br />(Description of the violatioM, P �.. J <br />This restriction of use is effective beginning on ����� L� 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 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 />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 Notic and time shown above by: <br />9 . <br />(Signature of per on issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />Sign re of perso eing issue notice) <br />D Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />