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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: � <br />TIME: CASE <br />LOCATION (PARK/OPEN SPACE): ----- ny <br />Ll� <br />z <br />"qanie� La First Middle <br />rs??'iF <br />DOB <br />I -D� <br />0&,-x� �, j- ow <br />City <br />State <br />Zip <br />Res. Phone: <br />Work 1jwni,_ <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 />')10 Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of U se is that on C I k 1 � ­' YOU Violated Section V(S �q ( o�o_ffie Park <br />and Open Space Rules, and/or Section of the Eugene Code, 197 t, and/or ORS — -- - - - - -- . <br />--- -------------- To wit, you. <br />( of the violation.) <br />This restriction of use is effective beginning on <br />_0Q1yj. and shall remain in effect until <br />If you enter in or use any City of Eugene park, open space or facility during the cffe-etivc 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 yule P - you are entitled to an informal hearing to contest this N oti cc. 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 Noti cc at the following address 182 0 Roosevelt, Blvd., E t erse, 0 R <br />97402. <br />IL nours (exclusive or Weeken,(IS) ol recetpt or Ine request for nearing. At the informal nearing tHe Diviuon Director will onbs! <br />consider testimony from 'you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t�c <br />incident. 'Tire Division Director may exclude anyone, other than you and those presenting testimony, from the infornial hearing. <br />This Notice shall rernain 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 />1-iTs <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 />White Copy: Public Works Grem Copy File Yeflow Copy: Report Copy Pink Copyz Re6pien& Gold Copy, OfficeT Appeal nofice Re ". "4"01 <br />