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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: /C�- <br />LOCATION (PARK/OPEN SPACE): <br />TIME: <br />Na me• ast . st Middle <br />�e <br />U <br />Res. Address: ity State Z'p <br />eje, 6 C <br />7/ <br />1 ,0j,C-Ae <br />CASE #: ];L— 1 537? <br />DOB: Race/ ex: <br />RA. P one: work Phone: <br />&0& -..- /74e;l , o-� <br />Under the authority of Administrative order No. 58- 03 -24 -F and Park and open Space Ruse 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 />4907 <br />The basis for this Notice of Restriction of Use is that on � /� you violated Section � of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />/,P am 1 4�CeXDI - 1 A) A-A <br />(Description of the violation.) <br />This restriction of use is effective beginning on 2 zo. shall remain in effect until <br />If you enter in or use any City of Eugene park, open space or facility during the effective pefiod 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 at the date and time shown above by: <br />(Signature of person issuingldelivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />X gnature o person being issued the notice) <br />to Copy: Public works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />