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1 e�C -) <br />NOTICE OF RESTRICTION OF USE <br />ATE: 1 �� <br />)CATION (PARK /OPEN SPACE):_ <br />and Notice of Right to Appeal <br />TIME: ``J K <br />9 r <br />CASE #: �� 1 5t) �� <br />Name: ast <br />First Middle <br />DOB: <br />Race /S x: <br />Res. Address. <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />ader the authority of Administrative Order No. 58- 03 -24 -F and Park and Open Space Rule R- 1.005(3), you are hereby <br />itified that you are prohibited from (check box): <br />K Entering in or using all City of Eugene parks, open spaces or facilities. <br />❑ q ` <br />tl��� = Z oti °CZ <br />ie basis for this Notice of Restriction of Use is that on y ou violated Section � - of the Park <br />Open Space Rules, and/or Section �1 of the Eugene Code, 1971, and/or ORS To wit, you: <br />lescription of the violation.) q l J <br />its restriction of use is effective beginning on I � 1 , and shall remain in effect until -j` / t- <br />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 />-ested and charged with criminal trespass in the second degree. <br />rsuant 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 />ormal hearing must be made in writing and filed with the Parks & Open Space Division Director ( "the Division Director ") <br />thin 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />402. <br />e Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />nsider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />.ident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />its Notice shall remain in effect pending any requested hearing. <br />iis Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />ma's ( - <br />(Signature of person issuing /delivering notice) <br />A)O�5a�6 Zj7 <br />ereby acknowledge receipt of the above Notice on the date and time indicated above. <br />0"W,6- M .51 <br />(Signature of person being issued the notice) <br />y: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />