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C I <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />)ATE: O 11� -- TIME: Q- <br />,OCATION (PARK/OPEN SPACE): <br />CASE #: H C j <br />z <br />Name: Last First Middle <br />DOB: <br />Race /Sex: <br />jj ^ �d <br />a <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />Jk OXX+ <br />1 J%K <br />Jnder the authority of Administrative Order No. 58- 03 -24 -F and Park and Open Space Rule R- 1.005(3), you are hereby <br />otified that you are prohibited from (check box): <br />S� Entering in or using all City of Eugene parks, open spaces or facilities. <br />'he basis for this Notice of Restriction of Use is that on , you violated Section of the Park <br />nd Open Space Rules, and/or Section , o I �1 % the Eugene Code, 1971, and/or ORS To wit, you: <br />Description of the violation.) <br />'his restriction of use is effective beginning on and shall remain in effect until <br />f you enter in or use any City of Eugene park, open space or facility during the effective perioct of this Notice, you may be <br />rrested and charged with criminal trespass in the second degree. <br />'ursuant 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 />aformal 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 />!7402. <br />'he Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />'2 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />onsider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />acident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />his Notice shall remain in effect pending any requested hearing. <br />'his Notice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />(�r 4�zc <br />(Signature of person issuing /delivering notice) <br />hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />spy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />