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NO TICE OF RESTRICTION OF USE MAR 2 1 ENV <br />and Notice of Right to appeal <br />m <br />I3rw.7 E; TIME: - CASE a <br />LOCATION (PARK/OPEN <br />F -. <br />Name: Last First Middle <br />DOB,: <br />ftaceESe,5 ": <br />x Bars. <br />Address: c t <br />State <br />LZ s <br />Res. Ph ®ne: <br />"cark Phone: <br />—:UILL—L <br />An tea +�tf <br />Under" the authority of Administrative Order Nos 58- 03 -24 -E and Park and Open Space Rule - 1.005(3), you are hereby <br />notified that you are prohibited from (cheek box): <br />Entering in or rising all City of ugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that ora —, you violated Section 0 of the Park <br />and Open Space Mules, and /or Section . of the Eugene Code, 1971, and/or ORS - To wit, you. _ __ <br />rA <br />(Description of the violation.) <br />rrri <br />This restriction of use is effective beginning on � �' , and shall remain in effect until r <br />If you enter in or use any City of Eugene park, opera 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 yule Ft -1.074 you arc 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 Directol") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the fallowing address: 1820 Roosevelt, Bled,, Eugene, OR <br />974020 <br />request 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 infornial hearing, <br />'rhis Notice shall remain in effect pending any <br />This Notice of Exclusion was delivered to the person named at the top of this Notice at the da e and time shown above by, <br />(Signature of person issuing/delivering notice) <br />I hereby° acknowledge receipt of the above Notice on the date and time indicated above. <br />r <br />(Signature of person being issued the notice) <br />Whoe Copy: Public Works. Green Copy; He Yeiluw Copy: Report COPY Pink Copy: Recipient Gold Cop Officer Appeal no ice Rev. ?03 <br />