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L i <br />NOTICE OF RESTRICTION OF USE t, <br />and Notice of Right to Appeal <br />DATE: D Calm TIME: - T � 10" 1 � � Lam' 1 <br />LOCATION (PARK/OPEN SPACE): C-MAQU E 111 ti,! / <br />z <br />Name: Last First Middle <br />EA 6 ' <br />DOB: <br />031 <br />Race /Se <br />Res. Address: city <br />Stag Zip <br />P 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 on are prohibited from (check box): <br />Entering in or usi all City f Eugene parks, open spaces or facilities. <br />9 <br />The basis for this Notice of Restriction of Use is that on 0 ( , you violated Section C� Y of the Park <br />and pen Space Rules, and/or Section ! ' 01 b of the Eugene Code, 1971, and/or ORS To wit, you: <br />� i <br />(Description of the violation.) ++ 1 <br />This restriction of use is effective beginning on_, and shall remain in effect until i� /I/ <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 hear' the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presentin es mony, 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 NotVy t the date and time shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated abov . <br />(Signature of 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. 04/03 <br />