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l <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal � � <br />DATE: � C�. TIME: CASE <br />LOCATION (Pt1RK/OPEN SPACE): <br />Name: Last <br />C2 .. <br />U <br />Res. Address: <br />First id DO Race/Sek <br />z �- <br />City State Zip Res. Phone: Work hone: <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 />Od Entering n or using all City of Eugene arks open spaces or facilities. <br />g g ty g p , p p <br />0. <br />The basis for this Notice of Restriction of Use is that on 0 2 0 you violated Section of the Park <br />and Open Space Rules, and/or Section 4, (10 of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on e)`S0-0 / �2 ,and shall remain in effect until � IC2 0/2. <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 Notice a e date and time shown above by: <br />l <br />(Sign person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated <br />4z / <br />(Signature of person being i sued the notice) <br />ite Copy: Public works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />