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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATL TIME: CASE <br />LOCATION (PARK SPACE): <br />z ....... <br />Name: Last Fiat Middle <br />DC) \:, <br />Racia/Sem <br />Lj <br />Res re Cy <br />_Add ss it <br />t <br />sallh <br />. <br />. .. . <br />Res Ph one <br />W k Ph <br />o r, one'. <br />. . <br />..... 16) <br />�?-(D 553D <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 you are prohibited from (check box): <br />1 Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) <br />This restriction of use is effective beginning on , 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 you are entitled to an informal hearing to contest this Notice. A request for an <br />7 7777777ATT r1,TT7fT T 7a M <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shail be not more than <br />of receitt of the reXpest tor hearingi. At the informal hearinog the Division Director will o"I <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. I <br />This Notice of Exclusion was delivered to the person named at the top of this Notice qf 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 above. <br />4 wiz ua -1-0 6k <br />(Signature of person being issued the notice) <br />White Copy Public Works Green Copy. File Yellow Copy: Report Copy Pink Copy: Recipient God Copy Officer Appeal notice Rev. 04,'03 <br />