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NOTICE OF RESTRICTION OF USE 15 <br />and Notice of Right to Appeal <br />DATE: D TIME: j CASE #: <br />LOCATION (PARK/OPEN SPACE): EST k- U W G,�,,` <br />z <br />ei <br />Name: La First � Middle <br />I. ADAM <br />DOB: � <br />Rack/ <br />� <br />R Address: � C <br />� t� <br />Zi� <br />Res. Phone: <br />,�" ✓ <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 />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 0 90 1 t IL , you violated Section of the Park <br />and Open Space Rules, and/or Section ' Z o of the Eugene Code, 1971, and/or ORS . To wit, you: <br />&C-,550b GJ N ARIGJ "Of s O Paos -F*1-11� <br />(Description of the violation.) <br />This restriction of use is effective beginning on V � is 1 7 2— , and shall remain in effect until D& 1 S 13 <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 N Ace at the date and ti e shown above by: <br />.—D /, (Signature of person issuing /d livering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />qAww, /- j , <br />( ig a e of person being issued the notice) <br />ropy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 f <br />i `' <br />