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NOTICE OF RESTRICTION OF USE �( <br />and Notice of Right to Appeal <br />DATE: 061M TIME: Mo CASE #: `L o <br />LOCATION (PARK/OPEN SPACE): 5 ? j2 K <br />H <br />Name: Last First Middle <br />DOB: <br />Rac <br />Kit(C.l lL�;i�� (� 0� <br />® 234 <br />�+" <br />Res. A (kesss: City <br />State <br />I <br />I Zip <br />Res. Phone: <br />Work Phone: <br />IT—AA I TLAAC I '— Pr <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 Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on �O you violated Section ae I Q of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: <br />(Description of the violation.) ,�I <br />This restriction of use is effective beginning on (f C f and shall remain in effect until — U7 [ i ( l <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"). e <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 persouuamed at the top of this No ice at a date and time shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being `issued the notice) <br />{�Vhitg Copy: Public Works" Orcen Copy. ,Fite - Veil ow Copy: JLep q Copy 'r Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />