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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DAM TIME� CASE <br />LOCATION (PARKY SPACE)� 1 L lt� <br />/ a d 1 <br />I MA qqM3 <br />z <br />Nanie, Last First Middle <br />Race/se <br />0 �W <br />7)z- <br />Res. Address City <br />S tale <br />zip <br />Res- P la Tree: o <br />Wotk Nione: <br />U nde• the authority of Administrative Order No. 58-03-24-'and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box)-, <br />P/ Entering in or using all City of Eugene parks, open spaces or facilities. <br />10 <br />The basis for this Notice of Restriction of Use is that on you violated Section the Park <br />and Open Space Rules, andjor Sectionq Iq 0 ofthe Eugene C od e, 197 1, and/or OR S To wit, vou: <br />A—, C J, C <br />(Description ofthe violation,) <br />This restriction of use is effective beginning on and shall rernain in effect until <br />Ifyou, enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you ti'lay 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 hearing to contest this Notice, A request 1`6r 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 />1'he Division Director shall schedule as 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. Al the informal herring the Division Director will only <br />consider testimony from u, C <br />rom yoity 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 inf'ormal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />P� <br />ofice a t date and tirne shown above by: <br />This Notice of Exclusion was delivered to the person named at the top ol'this this Notice a <br />(�,Sligrj,aturc of person issuing, notice) <br />I hereby acknowledge receipt cif the above Notice on the date and thile indicate(..] above. <br />(St"griature of'person being issued the notice) <br />Whin Copy: Puhlw Wvjks Gle^CnCopv. Fplc Ydhiw Cojp Repor Copy Pink ( opt Roopwn� 6,Ad ( op Ofl4m Appc;0 nonce kc 041:0, <br />