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NOTI E OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: 1��4061 TIME: 1 A00 Z;: -- CASE #: <br />LOCATION (PARK/OPEN SPACE): -- & <br />a <br />Name: a F �i t Middle <br />DOB: <br />Race/Sex: <br />U <br />Res. Addr. ss: � r�'" City <br />'&3-34& <br />State <br />,Zip <br />Res. Phone: <br />EcIeZ2!�� 10110--off- <br />Work Phone: <br />------ <br />& - 1 1111 .... ... <br />4��d? <br />Y--> !:� <br />All <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 />FE- <br />i <br />The basis for this Notice of Restriction of Use is that on ,you violated Section C�o th ark <br />and Open Space ules, and/or Section of the Eugene Code, 1971; and/or ORS To wit, you: <br />6AJ <br />/W4009 <br />(Description of the violation.) <br />This restriction of use is effective beginning --and shall remain in effect until --:� <br />g g on <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 Notice e dat and time shown above by: <br />(Signature f person issuing /delivering notice) <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />.e Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04103 <br />