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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />am'5 � 3 5 9 <br />DATE'. TIME CASE #� <br />LOCATION (P Al SPACE), <br />tinder 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 />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The hasiq for this Not of Restriction of Use is that on s/ you violated Section 1- 31000 of the Park <br />and Open Space Rules, and/or Section 0 <br />Nauie Last <br />First Middle <br />1)013. <br />Race :sex: <br />CoZ_ CArd 04 Sftl-5 <br />- Apj W-3 <br />EX, <br />CJ <br />Re�. Address. <br />city <br />State <br />Zip <br />Res-2� <br />tinder 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 />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The hasiq for this Not of Restriction of Use is that on s/ you violated Section 1- 31000 of the Park <br />and Open Space Rules, and/or Section 0 <br />of the Eugene Code, 1971, <br />and/or ORS <br />To wit, you: <br />Pr-t6(,5jjD-J 0):' APJ rjP,9)J I <br />CoZ_ CArd 04 Sftl-5 <br />- Apj W-3 <br />A(vooV <br />(Description of the violatiou.) <br />This restriction of use is effective beginning on and shall remain in effect until C 111liq <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 informal heating to contest this Notice. A request for art <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 4,� 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 iril'ormal hearing the Division Dircetor wit I 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 testimony, From the info al headrig, <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 perqon issuing/del. , ering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />11 - - — ----------- <br />(Signature ofperson being issued the notice) <br />While Copy: Nblic Works Goren C' opy Fite Yellow COPY: Repert Copy Pink Copy: Re, ipieni G old Copy: 0 fricer Appeal no! i ue 0WO <br />