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x - <br />DATE: � TIME: ' ®� CASE, #: � <br />LOCATION (PA OPEN SPACE): R AA_ <br />z <br />Marne: Last First 1b idclle <br />DOB: <br />Race. /Sex: <br />w <br />I <br />Res. Address: City <br />"., ✓' . - <br />State <br />Zip <br />Res. F'ho"I, <br />WDTk Phone: <br />1 ,5 . -, . ,<: <br />r <br />c <br />Under the autiro of Ad i istrative Order No. 58-03-24- and Farb and Open Space Rule R- 1.005(3), yarn are hereby <br />notified that you are prohibited from (check box): <br />is Entering in or using all City of p arks, <br />01 <br />The basis for this Notice of Restriction of Use is that on � � � you violated Section _ L10 – `'CL C of the Park <br />d Open Space Mules, and /or Section of the Eugene Code, 1971, and /or UPS . To Wit, you. <br />(Description of the violation.) <br />This restriction of use is effective beginning on <br />23 f ! —� and shall remain in effect until <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 y are entitled to an informal hearing to contest this Notice, A request for <br />inforinal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director <br />within * Ro os e ve lt, B <br />j <br />EuWu_e, 01 <br />97402. 1 <br />The Division Director shall schedule a time and place for the i nformal e conducted no <br />h ours req <br />consider testimony fi you, City personnel involved in the incident that resulted in this Notice, d other witnesses to the <br />pen 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 re <br />� <br />Signature ofperson issuing °deliverint naatice) <br />(. <br />' f ssu ed the notice ._ _. ) <br />ite Copy: Public Works Green Copy: File Yellow Copy. Report Copy pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />