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NOTICE OF RESTRICTION OF USE L <br />DATE-, and Notice of Right to Appeal hf <br />T FM E: CASE #: <br />-- --- - - — --------- <br />LOCATION (PA R K/OPF-N SPACE):._--W I (, <br />— - — - - -- ----------------- <br />1 3 1 �� <br />' <br />Nai Firs Middle <br />DOB� <br />Rac U,� S Ix <br />Res. A d,5ss, Oty <br />State <br />Zip <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), you are hereby <br />notified that you are prohibited from (check box): <br />7 Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis For this Notice of Restriction of Use is that on 41f 4f the Park <br />you violated Section i <br />and Open Space Rules, and/or Section of the Eugene Code, 197 1, and/or ORS —. To wit, you <br />(Description of the violation.) <br />This restriction of use is effective beginning onC61 � VA p and shall remain in effect until <br />If you enter in or use any City ol'Eugene park, open space or facility (luring 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 Rule R - you are entitl to an informal hearing to contest this Notice. A request for an <br />inforinal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division. Director") <br />within 49 hours (exclusive of wea kends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., E ugene, 0 R <br />97402. <br />The Division Director shall schedule a time and place for the ii 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 D ivision. Director may exclude anyone, other than you and those presenting testimony, from the informal heari ng . <br />This Notice shall reniain 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 />--- — ------- <br />(Signature of person issuing�deliverjng notice) <br />I hereby acknowledge receipt of the above Notice on the date and tune indicated above. <br />(Signature or issued the notice) <br />WhAc Copy: Public Works Gy"n Cupy h1c VCHOx Copy: kcporl Copy Pink Copy: Recipient Gold Copv: Of Appe,'A nc4ice Rev- 0 4/01 <br />