i- <br />Name: Last First Middle <br />D& <br />Race /s <br />7- <br />R Y f <br />Res. Address: C ity <br />State <br />F <br />one: Res. Ph <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that you are prohibited from (check box): <br />"W- 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 you violated Section _L the B <br />and Open Space Rules, and/or Section of the Eugene Code, t 971, arid/or ORS To wit, you:_ <br />b-z- loial?- I !azo, or -)Pc oimtrt,6A 0�: Ska�, <br />( of the violation.) <br />This restriction of 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 Open Space Ru 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 (exelusive 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 />of PSAHrig/ddiverrng <br />White Copys Putdic Works Gicen copy HC Yeltow CGPY. Report Copy Pink Copy: Recipient G old Copy Officer Appea notic e Kcv, 04103 <br />