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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />:TION (PARK /OPEN SPACE): <br />TIME: <br />CASE #: <br />fame: Last <br />G C t+ cocoa <br />First Middle <br />IN-J TNe-'�AL <br />DOB: <br />I o n <br />Race e <br />+� <br />.es. Address: <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />• the authority of Administrative Order No. 58- 03 -24 -F and Park and Open Space Rule R- 1.005(3), you are hereby <br />A that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />Isis for this Notice of Restriction of Use is that on � , r� , you violated Section of the Park <br />yen Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS G� �� .'fo wit, you: <br />".gkp T � p 1C c CotU - S TSSysgQ A 0ALT0 <br />iption of the violation.) P/42 l` IF—r, CLwg c�a (Z%T4 6 I'2)- A-I CJ d t:;zq r D, <br />estriction of use is effective beginning on SK I S , and shall remain in effect until (0 d <br />enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <br />d and charged with criminal trespass in the second degree. <br />ant 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 />al hearing must be made in writing and filed with the Parks & Open Space Division Director ( "the Division Director ") <br />48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />ivision Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />rs (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />er testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />it. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />iotice shall remain in effect pending any requested hearing. <br />'otice of Exclusion was delivered to the person named at the top of this Notice at the date and time shown above by: <br />Z�� &-oct-j ' I � --2 5� <br />(Signature of person issuing /d ivering notice) <br />y acknowledge receipt of the above Notice on the date and time indicated above. <br />1 -A 01 o 0 C <br />(Signature of person being issued the notice) <br />Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />