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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: Q ' 20 TIME: � * CASE #: <br />LOCATION (PARK/OPEN SPACE): lP � ,k &6c,S`_ ((� ��� ,:S <br />q 18 <br />H <br />Na Last <br />k5T <br />Fi s '[idle <br />�fle.rL <br />DOB: <br />a-3--t." r <br />Race /Sex: tA <br />U <br />Res. Address:. <br />City <br />State <br />,dip <br />Res. Phone: <br />Work Phone: <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 () Y ou violated Section of the Park <br />d Op e Space Rules, and/or Section %. of the ' Eugene Code, 1, 97 T, and/or ORS To wit, ,ou: Y <br />(Description of the violation.) <br />This restriction of use is effective beginning on ( 2 ,and shall remain in effect until 0 9 t21_0 l <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 Parr 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 />0 <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 go <br />(Si <br />I hereby acknowledge receipt of the above Notice on the date and time indicated <br />(Si <br />at the date and time shown above by: <br />;e of person issuing /delivering notice) <br />of pet's*n being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />