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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME. CASE <br />5 T I * 74cl <br />0 <br />LOCATION (PARK/OPEN SPACE N N C-,FZ� GUT 14 <br />2: <br />i Name: Last F1[ Middle <br />1 6Z:TOU N L <br />0 0 W I WAP—LFS <br />1)013: <br />10 [24 <br />Itace, Sex: <br />IM <br />Res. Address,: City <br />�,� <br />; �,l <br />State <br />t <br />Zip P <br />Res. Phonc: <br />Work Ph one� <br />,_ ft � <br />IF <br />U nder the a uthority of Administ rative Order No. 58-03-24-F and lark and Open Space Rule R- 1.005(3), you A re hereby <br />notilled that you are prohibited from (check box): <br />Ix Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction (if Use is that on you violated Section r 01 of the Park <br />and Open Space RLde/finl r Section q; _&T cif the Eugene Code, 1971, and/or OR - 1 To wit, you,: <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 cif` this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />PUSUant to Park and Open Space Rule 8-1.074 you are entitled to Lin informal hearing to contest this Notice. A request for an <br />infonnal hearing rnUsa be made in writing and filed with the Parks & Open Space Divis] on 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 (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 test i many, from the info gal 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 />(Signature of perskin issuinW'defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />4 <br />--------- -- --- <br />(Signature o person being issued the mAjco) <br />Whize Copy: Public Wofka Green COPY! Fitt YuHmv Copy: Ruport Copy Pink Copy: Re6pient Gold CUt�Y: Offlc+�r Appml noliiQc Rev 04K63 <br />41% <br />