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NOTICE OF RESTRICTION OFUSE <br />and Notice of Right to Appeal <br />DATE. 'TIME: CASE ft" <br />. .............. ......... . . <br />2, <br />LOCATION � PARK/011EN SPACE V "l- f , <br />at .m ..... ---- ---- ........ . . ........ ................... ....... <br />. . ........... <br />Nainc: Last First Middle DOB Race/ <br />L <br />Res. �AiddrLn�-,,� rcl, i ( Y State Rcs. llhuiie, <br />a1r. . I K -12 - <br />Under the authority of Ad rn in istra five Order N o� 58-03-24-F and Park awed Open Space Rule R- 1.005(3), you are here lby <br />notified that you are prohibited frown (check box): <br />Entering in or using all Cior of Eugene parks, open spaces or facilities. <br />. . . . . .. . . . .......................................... . . . . . . . . .................................................................... . . . ........................ <br />The basis for this Notice of Restriction of Use is that on you violated Section (-16— of the Park, <br />Rules, and/or Section L1he Eugeric Code, 197 L, anctic)r ORS Fo wit, y1rn]: 1 i 96 ol't <br />...... . ... <br />(Description of the violationji <br />'Uhis restriction of use is effective beginning on -,and shall remain in effect until. 0 <br />-6� tkt.5�, _.. i .. Zen, <br />. .......... -7/- <br />If you enter in or use any City of'Eugenc park, open space or facility during the effiective period of this Ni,,,)tice, you rylay be <br />arrested and charged with crimirial trespass in the second degree, <br />Pursuant to Park ind Open Space Rule R -L074 you are entitled to an hif6rmal hearing to contest this Notice, A request for an <br />in forinal hearing must be made in writing and filed with the Park,; & Open Space Division Director ("the Division Director"') <br />within 48 hours (,exclusivc ofweekends) oft-cecipt of this Notice at the rollowing address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a tinne and place for the informal hearing to be conducted, which sha,H be no. rnore than <br />72 hours (exchisive- of weekends) ofreceipt of the request ffir hearing. At the informal hearing the Division Director will only <br />consider le5tirriony froin you, City personnel involved in the incident that resulted in this Notice, arid anther witnesses to the <br />m6dent. The Division Direek.rpr may exclude anyone, other than you and those presenting testimony, ftoi-T�ii the inf6rinal htarinp <br />This Notice shall reinain in effect pending any requested hearing. <br />'This Notice of'Exclusion was delivered to the person trained at the top ofthis Notice at the date and time shown zabovie by� <br />C. VIACC #('wi . <br />.. . . . ........ . ....... . . . ...... I .................. . . .... . .. . ......... — I . . ................................. . ..... .. . . .... . . ....................... <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date arid time indicated above. <br />. ............ . . ...................................... <br />(Signature of person being isst Z) 1&") <br />WUe cr,.Py. pnhhc Work 0reen0Cul p,,,: He 11 Okrv, CupRepon Cop ,,, fin) 4 C'orsy� Rcuperik ( & ol d Copy: () rfi cer App a [ ii � c, I i ce IRev, 041103 <br />