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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />1 <br />C* mu5 <br />1-7A-0'00-'C" <br />DATE; T I N1 E: CASE #: <br />LOCATION (PARK/OPFN <br />z <br />Natne: Lasi Fi,st Middle <br />P4� 11 <br />I)OB <br />e, <br />Race 'S <br />ft- <br />L4 clf:- Kftl <br />C, <br />RZ <br />;acs. �kdd City <br />slaie Ix <br />Zip <br />Res. Phone: <br />I Work Plione: <br />Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />'6 Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />If you eraer in or use any City of Eugene park, open space or facility during the effective period ofthis Notice, you may be <br />arrested and charged with criminal trespass in the second degree, <br />pursuant to Park and Open Space RLde R- 1 074 you are entitled to an infori hearing to contest this Notice. A request for an <br />infori hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Dircctor") <br />within 49 hOL11 (CXCIUSIve of weekends) of receipt of this Notice at the following addresq: 1820 Roosevelt, BIV(L,, Eugene, OR <br />97402, <br />The Division Director shall schedule a tinge and place for the infortnal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) o reecipt of the request for hearing. At the int'ormal hearing the Division Director will only <br />consider testhriony from you, City personnel involved in the incident that resulted in this Notice, iind other witnesses to the <br />incident, The Division Director may exclude ran yone, other than you and those presenting testimony, frorn the infornial hearing, <br />This Notice shall remain in effect pending any requested hearing. ti <br />at Ith <br />This Notice offxclusion was, delivered to the p n <br />erson anied at the top of this�No at t1 ticc I t 'I and tirric shown above by: <br />-rin not <br />(S i anal tire o person i ssuing. c e e �ice <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being iSSUCCI the notice) <br />Whiw ( opy: Pulili�! Work, Green Copy: File 1 dlow Copy: Repon Copy Pin�k (opy: R"4neill GoM Copy Officer Apimil nonce: Rev, 0'1'�W <br />