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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: & /2-1. TIME: D35 CASE #: <br />LOCATION (PARK/OPEN SPACE): , Amk /f2ex zwe •� <br />�. <br />w <br />Name: Last First Middle <br />6 �� <br />DOB: <br />aV <br />Race /Sexy <br />--� <br />o6 <br />*4 m <br />6q/ <br />U <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />r <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 />Entering in or using all City of Eug ene arks o pen s <br />� g g ty g p arks, aces or facilities. p P <br />0 <br />The basis for this Notice of Restriction of Use is that on O / A you violated SectionZfa S" of the Park <br />and Open Space Rules, and/or Section #,7�of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on AW7.5 1 and shafl remain in effect until A57 <br />If you enter in or use any City of Eugene park, open space or facility during the effective yperiod 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 />974020 <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 infonnal 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 Nonce at the date and time shown above by: <br />W�. <br />qlez:: - 97 <br />(Signature of person issuing/delivering notice) <br />s r � <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />Z;q F 4 � "3 , 44 a, Or O--X; <br />(Signature � if persod • issued the notice <br />White Copy: Public Works Green Copy: Fife Yellow Copy: Report Copy Pink Copy: Recipient Cold Copy: officer Appeal notice Rev, 04i43 <br />