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NOTICE OF RESTRICTION OF USE <br />I ;,-- Z- 2- - <br />DATE. <br />and Notice of Right to Appeal <br />TIME: 1� <br />gN� � W-tN3 <br />CASE #: fq- <br />LOCATION (PARK/OPEN SPACE): IJ ftmloal� �- <br />Z- <br />Name: Last Fin-t el- Middle <br />DOH: <br />Racc/scx: <br />(A 1k t <br />t 3 <br />14PA <br />LW <br />Res. Address City <br />State <br />Zip <br />Re. 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), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) <br />This restriction of use is effective beginning on Si ~ � , 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 cruninal trespass in the second degree. <br />Pursuant to Park and Open Space Rule 8-1.074 you are entitled to an informal hearing to contest this Notice, A request rot an <br />infornial hearing in 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 Dircetorsheall schedule a time and place !'or the intbrinal 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, front 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 tin shown above by: <br />G-vr- �� --------- ------ <br />(Signature ofper iqquing"delivering notice) <br />I hereby acknowledge receipt of the above Notice on flic date:. and timc indicated above. <br />(Signature of person being issued the notice) <br />44 hiti: Copy, Pubh Wnrks Caern Copy: File y0knv Cop : R pua Cup <br />, Y Pink Copy Ru6piCnL i Copy Ofrixr Appeal nofi,,x <br />