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� C") I <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />k 10, <br />DATF TIME: CASE <br />LOCATION(PA1RXY1()PEN SPAC'E,): ................ ...... . . --- . . . . .... -----...................... . . . ....... . .mm.. . . . . .................................. ... <br />. ...... ....... <br />Manx,: Last First Middle D(ff X <br />V <br />Res, Addro,,,,-. City Stake Zip R.es. Phonc�: MA Piwpne� <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open. Space Rule 114.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />M(— Entering in or using all City of Eugene parks, open spaces or facilities. <br />W <br />The basis for this Notice of Restriction of Use is that on - , you violated Section I�01 P� 4)'the Park <br />. .. ...... ................ <br />aTId Open Space R.Wcs, and/orSection ............... . .......... . Y . . . . ............. . <br />....... (�, . . . ..... .. ...... of the Eugene Code, 1.97 1., an&'or MS t'ow'lt, knv <br />. . ............................... ......................................................................... . . ........................... . . . . . . ................ . . . <br />(Description of the violation.) <br />This restriction of" use is effective beginning on .. <br />. ............... and shall remain in effect unfif . 5 <br />... ....... <br />Ifyou enter in or rise any City of Eugene park, open space or facflity during the effective period el than Notice, you rnay be <br />arrested and charged with criminal trespass in the second degree. <br />PUT'SLiant to Park and Open Space Rule R-&,074 you are entitled to an infom.-ial hearing to contest this NotieioA ro,]uest 16r an <br />inforrnal hearing must be inade in writing and filed with the I'larks & Open Space Division Director ("'the 13ivisjon Directcor") <br />)giffini 48 hours (exidusive c,& weekends) of receipt of this Notice at ithe Ulowing address: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedulc U time and place for the informal hearing to be conducted, which shall fa u; not more 0.mn <br />72 houm (exclusive of weekends) of receipt ofthe request for hearing. At the inff .)rryurfl. hearing. the Division Director will only <br />consider testis iony from you, City personnel involved in the incident that resulted hi this Nioiiiclie, and other v,�itiiesscs to, thc <br />incident. The 1.)ivision Director rnay �exclude anyone, other tban you and those presenting testiffiony, from the infori-nal hearing, <br />This Notice shall re inain in effect pending any requested hearing. <br />This Notice of'Exclusion was dchvered to the person named at. the to of this Notice at mend time shown above by: <br />(Signature orperson iq�suing/delivering notu,,ru) <br />I hereby acknomWge receipt ofthe above Notice (in the date and time indicated above, <br />( Signature (.Wperscm being i ss kiled the ratios) <br />Yllte (.:opy: public "Vorks Llrcwn Crr.py: Nb:; Y61w.v Cq),re. Report Copy Nnk CopyRe6pie-nm (3,14d r7upy, Cjffio�r AppuO nonk;C R,vl% <br />