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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATL TfME: . -cR4 CASE:#: <br />LOCAT101\i (PAR.K/OPEN SPACE),..._. <br />_ . . . .......... ... ....... <br />Name. Last Fir'St Middle DOB: Rl,acc/Scx� <br />City State Zip Res. Mime: Worl, Phone: <br />Res. Address� <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule 1 -1 .005(3), you are hereby <br />notified that you are prohibited from (check(boxy, <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />..... . ..... . . . ...... ---- . . . . . ....... ........... --.- . . . ............ —11 ....... . . ........... ---- . ............ <br />The basis for this Notice ofRestriction of Use is that on ffblv_L . ....... . ...... -, you violated Section... ... . ....... . . .. . . .......... , c& the Park <br />and Open Space Rules, and/or Section 4la, — ofe E <br />thurge ne Code, 197 1RS , arid/or OTowit, <br />A <br />(Description of the violation.) <br />0 <br />This restriction of use is effective beginning 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 TNk.)tice, yt,,ot,i may, be <br />arrested and charged with criminal trespass in the second degree. <br />PU.Maut to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice, A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space.Divisiun Director ("the Division Directof") <br />within 48 hours e,A%veckends) ofreceipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shail schedule a, titne and place for the inforrnal hearing to beconducted, which shall lbe not rnore than <br />72 hours (eX,CltjSjw,e ofweekends) ofreceipt of the request for hearing. At the informal hearing the Division Directorwill only <br />consider testimony from you, City personnel involved in the incident that resulted in this '614,utice, kind other witnessca,, to <br />incident. The Diviskm.Director may exclude anyone, other than you and those presenting testimoiry, from the informa] fre-aring <br />This Notice shall remain in effect pending any, requested bearing. <br />This Notice of Exclusion was delivered to the person narried at the top ofthis N ic-- <br />oh? at the dndfi <br />ate acral s <br />ehown above 1.,uy: <br />(Sign t1urle o <br />f person issi.iing/delivering mAicc <br />"Ill ) <br />I hereby acknowledge reocipt ofthe above Notice on the date and titne indicated above, <br />7 <br />-;on bein <br />(Isig Li o p&, issued tire notice) <br />Wkkr Copy: Public Works (keon ojpy: Fih�, Yellow ('Uipy� Report Copy Nntk Ccq)yR.p6piftmi Gold C"opy: Gifflicu Apput no6d:iv Ram104103 <br />