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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE TIME: Lf CASE <br />LOCATION (PARK/OPEN SPACE): PAk-k- <br />z <br />Namc: Las First Middl <br />D011� <br />- fy <br />Raceisex: <br />(OT <br />Res. Addre.": 0 tv State <br />.r It, <br />7 <br />Zip <br />2-1 - - <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 yGu are hereby <br />notified that you are prohibited from (check box): <br />1 <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />W <br />e - e <br />The basis for this Notice of Restriction oft s 0 <br />e is that on 11-1-11� you violated Section 010 0 � park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS -- 1 To wit, you: <br />I Q I �Y <br />(Description of the violation.) <br />This restriction (if use is effective beginning 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 Opeu Space Rule R- l 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 fisilowing address. 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the Hilbrnial 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 info, rtnal 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 three shown above by <br />- — - - ---------- <br />(Signature of person iSSUIng/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />0 C A-ACAA-- <br />(Signature of person being issued the notice) <br />White Copy: Puhlw Works Green Copy: Fih� Yellow Copy: ReVort Copy Nn k Copy Rc4 (Ad C'Opy; Offircr Appeal notice Rev, IWZ03 <br />