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m3i11 <br />NOTICE OF RESTRICTION OF USE <br />DATE: 3-19- <br />LOCATION (PAR /OPEN SP <br />and Notice of Right to Appeal <br />`TIME CASE # <br />M <br />z <br />Nam- si H liddle <br />1) <br />Race,/Sex: <br />U <br />des, rt ss: City <br />State <br />Zip <br />. ........... <br />Res. Phone: <br />Work Phone: <br />s; r 1� �liiiii 1111111pl� �111111 pill 11111 11 liq 11111 11�11111 <br />E] 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 ll - �12 you violated Section of the Park <br />Space Rules, and/or Section --- of the Eugene Code, 1971, and/or ORS I To wit, you-._ <br />(Description of the violation.) <br />This restriction of use is effective begin ninc on and shall remain in effect until <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- 1.0174 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 the date and time shown above by: <br />(Signature of person issuing/defivering 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 />White Copy Public Workw Green Copy: File Yellow Copy: Report Copy Pink Copy Recipient Gold Copy Officer Appeal ntAice Rev. 04,'03 <br />