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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE. C ( P <br />C— __ TIME: CASE <br />LOCATION (PARK/oPEN SPACE) <br />7- <br />Name: Last First Middle <br />j <br />DOB: <br />Race/Sex: <br />Res. Address: city State <br />Zip <br />Res. Phone: <br />Work Pbone! <br />J-4 Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on 44 you violated Section <br />A --(J-Aq�417 the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or 0 RS ---. To wit, you:_ <br />(Description of theviolatioir) <br />This restriction of use is effective beginning on and shall remain in effect until 6S <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. I <br />Pursuant to Park and Open Spacc Rule R- 1 .074 you are entitled to an informal hearing to contest this Notice. A request for an <br />inforrnal 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: 820 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 frorn 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 inforrnal 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 titne shown above by: <br />(2 111 t c--3 1 -f, <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person eing issued the notice) <br />White Copy: Pubfic Works Breen Copy: File YeilGw C opy : Repon Copy Pink Copy Recipient Gold Copy: 0 f� er Appeal notice Pew. 04103 <br />