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NOTIC , T OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TI M E CASE <br />. .... .......... . . . ...... . ....... .. <br />LAXWFION (PA1.KJ0PF.,.N SPA(:",F)�!A­ f 1AA <br />. . .................. . - ... . ..... . ..................... . . . . . . . ........... . ................... -- ........................... .. . . . . . . . ..................................... .. . . . . <br />. . ....................... <br />Naine: Last First Middle DO <br />. ............................. - <br />Res- % dress: City Ska e Zip Phoney 'u'4 ML Pllloile: <br />. . ........ ... . <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule 11-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />;I Entering in or using all City of Eugene parks, open spaces or facilifies, <br />The basis for this Notice o r RZIStriCtiOrl of Use is that on you violated Slecticni I.W—W)of tile Pftrl�, <br />and Open Space Rules, and/or Section -q--IQ,--of the Eugene Code, .197 1, and/or ORS Tol wit, YoU <br />nM _...... . .... I ................................... . . ...................... . . . . ..................................... . . . . ................ . <br />11 . .......... ..................... .. ...... .......... .. <br />(Description of the violakionj <br />This restriction of use is effective beginning on ands all remain in effect until, 117 <br />Ifyou enter in or use any City of Eugene park, open space or, facility during the eMctive period of aiis Kcptice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park arid Open Space Rule R-1 .074 You are entitled to an infornial hearing to, contest this Notice. A, request fbr an <br />inforinal hearing inust be made in writing, and tiled with the.ParkLs & Open Space Division Director ("'the Division Direck-lir") <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 qhaH schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (CXCh,LSiVC orvvieekeads) of receipt ofthe rcquest for hearing. At the informal hearing the Division Director MH only <br />consider testirriony firorn you., City personnel involved in the incident that resulted in this "Notice, and other Yritnesces iice the <br />incident. 'The Division Director may exclude anyone, other than you and those presenting leshirr. niy, firclin the infornial he,,,aring. <br />This Notice shall remain in effect pending any requested hearing. <br />`This Notice of Fxclusion was delivered to the person named at the top ofthisby� Notice at and tirne sh�oovk. <br />"m ab,� <br />;t" #11,0- <br />(Signature of'person issiaing/dchvieHng nodee) <br />I hereby acknowledge recei[,nt of the above Notice on the date and time inclicated above. <br />(`Signature of"person being issued the niodice) <br />I'VIIIIIe Copy Giieea(`opy He Yr.-Akox Copy! Rqaurl Copy Pink CopyKn.-ipi,oW Ga,�,Lj ('opy, I',',qTwcr Appe d Rr,CMAKl <br />