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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE <br />--1 <br />LOCATION (PARK/0PEN SPACE): /-- ft-lcu <br />z <br />Narne Last First N-fiddle <br />DOB - 1 <br />W <br />"DAP110AI <br />.d <br />� C4 <br />Res Address; city_ — FStafe <br />Zip <br />Res. Photie: <br />W( Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule ft"1.005( you are hereby <br />notified that you are prohibited from (check box): <br />N5V, 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 - IT-1 you violated Section <br />: V 2 W <br />LaPA Q4 of the Park <br />and Open Space Rules, and/or Section <br />of the Eugene Code, 1971, an&or ORS _. <br />To wit, you: j <br />-;� or- A-tj Xca C2&lnihaa <br />(Description 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 Rule R-1.074 you are entitled to an infornial 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 info al hearing to be conducted, which shall be not more than <br />72 hours (exclusive ofweekends) of receipt of the request for hearing.. t 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 testirnotty, from the in Po al 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 />- — ------ — — ----------- <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 />Wh Nt e Cc)py , Pub I ic W arks (hems Copy: Fite Yellow Copy! Report Copy pink Copy: R - (44d Copy, Ofrwo Appcu rw6co knew, 0443 <br />