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NOTICE OF RESTRICTION OF USE bAS
<br />and Notice of Right to Appeal
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<br />............................... . .
<br />LOCATION (P .1[ SPA.CE)
<br />Nanw! LaM First Middle DOB: Racc/sz
<br />z 7:
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<br />Res, Address,: CRV State Zip Res, Phom: Work Phonc�
<br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby
<br />notified that you are prohibited from (check box):
<br />FFA Entering in or using all City of Eugene parks, open spaces or facilities.
<br />111- —
<br />....... . ..... . . . . . . ................ --1 . ... .................................................................................. . . ....... . .............................................................................................. . . ..... — . .... .
<br />60,
<br />Yhe basis for this Notice of Restriction of'Use is that on a.A !�04� . . . ........... --' you violated Sectioiri, j Park.
<br />. . . .......... ....... ...... ..........
<br />and Open Space Rules, and/or SectionPq of` Eugene Code., 197 1, and/`or 0R.S To wit, yow_
<br />..... — ------- ... . . . . . . . ........ . .......................... . . .
<br />(Description of the violation.)
<br />is restriction of use is effective beginning on .......... and shall remain in effect until
<br />Kyou enter in or use any City of'Eugene park, open space or facility during the effcctive period of this Notice, you may be
<br />arrested and charged with criRninal trespass in the second degree.
<br />Pursuant 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 Division Director ("the Division Director")
<br />within,48 hours (exclusive ofweekends) of'receipt ofthis Notice at the following address; 1820 Roosevelt, Blvd., Eugene, OR
<br />97402.
<br />The Division Director shall schedule a time and place for the inion -nal hearing to be conducted, -which shall be not more than
<br />72 hours (exclusive ofwo,,rwkcnds , ) of receipt ofthe request for hearing. At the infomial hcaring, the Division Director will curlyconsider testiniony frorn you, ( ' , ity personnel involved in the incident that resulted in this Notice, and other witnesses to the
<br />incident. The Divisioni Direcl 'or may exclude anyone, otherthan you and those presenting testiniony, firorn flic informal ho-,.-aring.
<br />This Notice shall remain in effect pending any requested hearing.
<br />This Notice of Exclusion was delivered to the person narned at the top oftfus Notice at the date and tin shown abovt,, by:
<br />I ------ . .......... ................ I - !&- --1
<br />(Signature of"person issuing/defivering no(ice)
<br />i hereby acknowledge receipt of the above Notice on the date and tirne indicated abow.,,,
<br />(Signature of person being ir,,,suied the riotit-:1e)
<br />(,rly: Pk&K! Wrol,,,r 11-i'lleel7 Copy� F4. Yeflow Fopy� Rr;,,poirl ("opy iron (L'opy, RtNipiiont Gold Copy! Offiecrr AppcO nri6rx R,,,,, 04103
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