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NOTICE OF RESTRICTION OF UISE <br />and Notice of Right to Appeal <br />M- <br />DATE. <br />LOCATION (PAR K/OPEN SPAC,E): <br />tv-i �-t <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open, Space Rule R-1,005(3), you are herchy <br />notified that you are prohibited from (check box)- <br />(Description of the violation.) <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 />infionnal hearing Must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive ol'weekends) of receipt of this Notice at the following address. 1820 Roosevelt, Blvd ®, Eugene, OR <br />97401 <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 front 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 a.nd 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 nanied at the top of this Notice at the date and time shown above by; <br />6 , 6OFF I <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 being issued the notice) <br />Whitc Copy, Public WoT GrCk'nCopy! File Yellow Copy: Report C013-y Pink Copy; Rccipicnt G ol d Ci �py: 0 fficer Arpeal notice Rm 0414)3 <br />Name: Last First MiMe <br />he - "c d <br />DOB: <br />1�ace/s e <br />- N t U,,e <br />Res. t" Address� <br />Nit <br />zip <br />F <br />Res. Phone: <br />Work Phone: <br />I 6 4 <br />(10 <br />tv-i �-t <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open, Space Rule R-1,005(3), you are herchy <br />notified that you are prohibited from (check box)- <br />(Description of the violation.) <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 />infionnal hearing Must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive ol'weekends) of receipt of this Notice at the following address. 1820 Roosevelt, Blvd ®, Eugene, OR <br />97401 <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 front 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 a.nd 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 nanied at the top of this Notice at the date and time shown above by; <br />6 , 6OFF I <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 being issued the notice) <br />Whitc Copy, Public WoT GrCk'nCopy! File Yellow Copy: Report C013-y Pink Copy; Rccipicnt G ol d Ci �py: 0 fficer Arpeal notice Rm 0414)3 <br />