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LOCATION (PARKJOPEN SPACE): <br />Pt," MXL 006 64tz- <br />Vj <br />Name: Last Fir"A Ngfiddle <br />R-i C- TO S IF <br />DQ <br />qq 3 <br />Race" - ex: <br />L) <br />ET A) L) <br />Res. Address, t <br />h <br />State (L <br />Zi p <br />; <br />lees. Phone: <br />Work Phone; <br />Under 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 basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS TO wit, you <br />(Description of the violation,) <br />Oy <br />This restriction of use is effeetive he ginning 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 11. -1.074 you are entitled to an infien 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 wi I 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 infon 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 <br />I hereby acknowledge receipt of the above Notice on the date and <br />at the date and tin shown above by: <br />, e of person issuing/delivering notice) <br />(inat of7 4 <br />Sgure of arson being is�sd the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rey. (14!03 <br />