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NOTICE OF RESTRICTION OF USE 5 5 '7 1 t0 <br />and Notice of Right to Appeal <br />- ------ !�/ ............... .. . . .............. . . . . ........................................... . . . . . . . ................... .. . ... .. <br />LOCATION (PARK./i SPMT`4� sei�'Fy - --------- <br />FiN- Middle DOB-, Rac�,/Sfi <br />Naine, <br />V Y' Z.1 <br />Res, Addresq� Zip Res Phot�e- Work Phoni <br />Under the authority ofAdministrative Order No. 58-03-24-F and Park and Open Space Rule . 1.005(3). you are hereby <br />notified that you are prohibited from (check box): <br />. . ........------ <br />niering in or using all City of Eugene parks, open spaces or facilitieS. <br />------ <br />.................................... . ................................. . . . . . . . . ................... . .. . . .......................... . .................... . . . ........ . . . . ..................................... . . <br />The basis for this Notice of Restriction of Use is dw on 16IY06 Of the Park <br />and Open Space Rules, and/or Section 6 of the Eugene Code, 1971, andh.)r OR; To wit., yotr__ <br />.................... . . . . <br />S <br />nz__� _'g� ................ . . . . . . . . ................................ . . . . . ............ . ................................................. s : <br />(Description of the violation.) <br />This restriction of use is effective beginning on 60� V d and shall remain in effect until I? A16 <br />. . .... ..... ...... XI <br />ifyou enter in or use any City of Eugene park, open space or l"'Icility during the effective period of ffifis Noticie, yolu may be <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and i Space Rule R-1.074 you are entitled. to an informal heziring to contest this Nofte. A request f6r an <br />inrormal hearing tnust be inadc in writing and filed with the Parks & Open Space Division Direclor ("the Diviskm Dirt,;1c.ior") <br />within 48hoirs (exclusive ofweekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugi 0111. <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be i[l(..)( rriore than <br />72 hours (exi (if weekends) of receipt of the request for hearing, At the in lon-nal hi the Division Director will only <br />consider testimony frcnn you, (Ity personnel involved in the incident ti'ifat resulted in this Notiuie, and othi witnesses tif,)the <br />incident. The Division Director may exclude anyone, other thariyou and those presenting testirni fti inF(.-.Prrnal hiearhig, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice o[Exchision was delivered to the person natned. at the top of this Notice at the a(c and uric shii rabovie, bT <br />. ...... . . w . . . . ........... . .................................... <br />(SignatureOrperso iss,iiii)gldeliveririgiikaticc,) <br />I hi ac kni ledge reccipt of the above Notice on the dnte and titnc indicatedabove, <br />....... . ... I .......... ....... .. ......... I .......... . .... . ..... . . . ............ . . <br />(Signature u'person being issued the noni <br />Whilo Cop , Pi-iblic ","i ti rl,"en Copy: hle Ye. I k;'V Copy. Rer,on i Py Pink CopykiCRP: uenif (3 ;Ad Copy � 0 twee A p o11 miai u,,- Rev . if) 1 1103 <br />