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DATE: �� Z <br />LOCATION (PARK/OPEN SPACE): <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />TIME: <br />r - rA/ <br />1" <br />TO N <br />CASE #: 1 U 3 6 - 7 <br />z <br />Name: st F' st tddle <br />BARN � TT R ER -r EVAN � <br />DOB i � � � <br />0 6 <br />Rac�e/S� <br />U <br />Res. Ad e City <br />oMe LC <br />State <br />Zip <br />Res. Phone: <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 Eugene parks, open spaces or facilities. <br />D <br />The basis for this Notice of Restriction of Use is that on ( 97 3 �2 1 Z , you violated Section f `� of the Park <br />and Open Space Rules, and/or Section 4,m of the Eugene - Code, 1971, and/or ORS To wit, you: <br />&LA P -Ay-� gk, O " f OSSAO 'NLcoi4oL <br />(Description of the violation.) <br />This restriction of use is effective beginning on 57 shall remain in effect until Dg 3 (12- <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) ofreceipt 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 />the person named at the top of this Notice at the date and time shown above by: <br />r �f "�- <br />(Signature of person issuing /delivering notice) <br />Notice on the date and time indV'caXid above. <br />i <br />w <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 <br />