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I- <br />N , <br />- i L t First id <br />as Mdle <br />DOr <br />Raee/se�: <br />Z <br />Aiie, <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Pfione: <br />Under the authority of Administrat ;-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 />A( Entering in or using all City of Eugene parks, open spaces or facilifies <br />a <br />The basis for this Notice of Restriction of Use is that on 4 ),1112. you violated Section of the Park <br />I W- <br />and Open Space Rules, and/or Section --- of the Eugene Code, 1971, and/or ORS -, To wit, you: <br />LKT7 Uk) C A ffi�77CLf,'% <br />(Description of the violation.) <br />This restriction of use is effective beginning on e ' and shall remain in effect until kil )Q I I I <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 the date and time shown above by: <br />(Signature ofpersn issuing /delivering ce) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />Signature o person b ing issued the notice,) <br />White Copy: Public Works (jr"n Copy: File Yellow Copy: Report Copy Pink Copy; Recipient Gold Copy: Officer Appeal notice Rev, 04/03 <br />