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`51 �01,4 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal fN er /, 7, <br />DATE: jj � C' TIME: �7 CASE #: <br />LOCATION (PARK/OPEN SPACE): <br />H <br />a <br />Name: Last First Middle <br />'cc ,qi�.� ��s�P <br />DOB: <br />Dl' � S <br />Race /S x• <br />f,� <br />Res. Address: j j � �� � Ci� <br />f <br />State <br />Z�}p <br />7 7 <br />Res. Phone: <br />'3 <br />Work Phone: <br />lid <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 />i- Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on d ll / `!-Z you violated Section <br />and Open Space Rules, and/or Section T of the Eugene Code, 1971, and/or ORS <br />To wit, you: <br />F T- 5 5f-! 5 -5 <br />(Description of the violation.) <br />This restriction of use is effective beginning on 'z� -l2 , and shall remain in effect until — 2, ° r -. <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 tic a the date and time shown above by: <br />h � <br />(Signature of person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Vhite Copy: Public Works <br />Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice <br />of the Park <br />Rev. 04/03 <br />