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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />N Vj:�JA-a <br />DATE: <br />TIME: CASE #: <br />D013i <br />� <br />Race/Sex: <br />-1ket1111 <br />LOCATION (PARK/OPEN SPACE):"" <br />'As <br />- - ,2 <br />7- <br />Name: Last First Middle <br />- <br />D013i <br />� <br />Race/Sex: <br />-1ket1111 <br />'As <br />- - ,2 <br />Pies. Address: City <br />Stale <br />T- <br />Zip <br />Res. 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 you are prohibited from (check box): <br />and Open Space Rules, and/or Section <br />q K) 1 <br />,V 1,- "4, Ttv <br />of the Eugene Code, 1971, and/or CARS i' e q. To wit, you- <br />01, <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <br />-AA <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 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. <br />This Notice of Exclusion was delivered to the person named at the top of this N74 at the date and time shown above by: <br />(Signature of person issuing/delivering notic <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />-z <br />(Signature of person be ing issued the notice) <br />While Copy: Public Works Green Copy. File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04!03 <br />