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NOTICE OF RESTRICTION OF USE <br />N5 5j 1571 P <br />and Notice of Right to Appeal <br />DATE: TIME: <br />5j I �zt)&J <br />LO CATION (P ARK/ OPEN SPA CE) - ,-, - w <br />d. <br />c. <br />Nam ast Firs L <br />DOB: <br />CL <br />Ri - e"Sgx , <br />Re,, Ad otitis: city <br />State <br />Zip <br />RL Ph)ii <br />FkTho <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space -Rule IS- I .005(3 .). you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using an city or Eugene parks, open spaces or facilities. <br />ED <br />(DescriptiQo of the violation.) <br />This restriction of use is effectivc beginning on J and %hall reinain 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 nray 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 inforinal hearing to contest this Notice. A request for an <br />info al hearing must be made in writing and filed with the Park-, & 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 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 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 testimony, from the informal 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 h, 111 ;d- jirneshownaboveby: <br />c <br />'oil <br />(Signature of - erson issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indic <br />MAC c�Py� Pubfic wurk� Green Copy; Fite Y d1ow C opy: Report Copy Pink Copy: Recipient 661d Copy: Officcr Appeai nefice R, Y, 04!03 <br />