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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: D5 CASE #,- <br />LOCATION (PARK/0PEN SPACE).,---W1- <br />z <br />Nanie� l,alqr First addle <br />-- <br />D()B� <br />Race/Sex: <br />u <br />.1 r a z- m 1 4 <br />i E - <br />Res. Address: (7 ity <br />47�� <br />State <br />zip <br />Res. Phone: <br />Work Phone: <br />------------ -- <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R- 1.005(3), you are bereby <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />91, <br />Pursuant to Park and Open Space Rule R -1.074 you are entitled to an infonrial 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 49 hours (exclusive of weekends) of receipt of this Notice at the Following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Di vision Diree tor shal schedul c a time and place 1`0 the informal hearing to be conducted, which shal be not rnore than <br />72 hours (exclusive of weekends) of receipt oft e request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that MsUlted in this Notice, and other witn"ses 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 reinnin 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 />0 ��a4 Ub3l I— <br />(Signature of person issuing/delivering nonce) <br />I hereby acknowledge receipt of the above Notice on the date and time indic <br />Mili b - C opy: 1`01 id WE wk s� [;recta Copv_ Fik Ycllu* Copy RepE,rt C[,py PEA Copy Rmpiura Gold Copy Offic a A ppea I nExicc Rm 04/03 <br />