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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: ­ 0 77 q& _ CASE #: <br />'F I <br />LOCATION (PARK/OPEN SPACE):_ f��f" 6 <br />0 6 q6 <br />13-3S <br />Name: Last First .Middle <br />DOB: <br />Race./sex: <br />z 01 9L <br />Res, Address: Cit} <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />notified that you are prohibi ed from (check box): <br />0 Entering in or using all City of Eugene parks, open spaces or facilities. <br />NJ <br />The basis for this Notice of Restriction of Use is that on 0*2 07 4 0 , you violated Section IDY& of the Park <br />and Open Space Rules, and/or Section A, the Eugene Code, 1971, and/or ORS <br />(Description of the violation.) <br />ssk-95-ra/d f/- <br />To wit, you:_ <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 49 hours (exclusive ofiAeckends) 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 infori 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. — 1 <br />This Notice of Exclusion was delivered to the person named at the top of this Not' he date and ti s o ove bv- <br />W <br />(Signature of pe on iss g/d - 'vering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time ld above. <br />Ix <br />(Si <br />- ti I. o g issued the notice) <br />While Copy: Public Works Green Copy: File Yellow Copy Report Copy Pink Cupy; Recipient (Iold Copy: Officer Appeat notice Rev. 04'03 <br />