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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: �[vZ� � � -TIME: f Z-�� CASE #: ' zwol� <br />LOCATION (PARK/OPEN SPACE): CPARK)elA� ImucoG`a, 41-3 PIKI�„ <br />z Name: Last S First Middle DOB: Ra e /Sex: <br />a <br />U <br />� Res. Address: City State Zip Res. Phone: Work Phone: <br />/N-Ob ^A <br />Under the authority of Administrative Order No. 58- 03 -24 -F and Park and Open Space Rule R4.005(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 (��(jZZ 1 * � you violated Secti on ��f the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS <br />ago C A"Ax ., <br />(Description of the violation.) <br />otj <br />_. To wit, you: <br />This restriction of use is effective beginning on b and shall remain in effect until D 1p ZI 13 <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 at t d time giown a <br />Si afore of person issuing/ elivering notice) <br />l <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />.... . . ................... . <br />i afore of person being issued the notice) <br />Bite Copy: Public works Careen Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />