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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: CASE <br />.............. . ... . . ................ . . . . . . . . ........ . . ............. . . . .. .................. . . . . . .. .......... . ............ . . . . ............. . <br />LOCATION (PAR K`C)PEN SPA( -T.,):______ <br />Name; Last First Middle DOBacr„Sex <br />IL 11 111,111i <br />R&;. Address:, C"ily State Zip Rea "" Mone: Work Pfinnc: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R4.005(3), you are her-eby <br />notified that you are prohibitee; rrom (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on -1 , you violated Section I Qj[! [I )Chir F"ark, <br />6i i I - -------- .. .. .. 11 <br />and Open Space Rules, and/or Section O.K) - of the Eugene C. l-971, and/or ORS . . ................:, -Fc) wit, You . . . . .............................. <br />.......................... <br />. ......... . ............. - ............ . . ..... . ..... . . . . . . . . .................... . . ....... . ....... . .. <br />(Description olf the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until <br />If you enter in or use any City ofEugene park, openspeee or facility, during the efl&tivie period of this Notice, you inay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space RuleIR.-'l 074 you are entitled to an informal hearirgtar csmites( this Notice. AreqUestibran <br />inti.)rmal hearing must be made in writing andfiled with. the Pasks & Open Space Division Director ( `tile Division Diredor") <br />within 48 hours (exclusive of week -ends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR. <br />97402. <br />The Division. Director shall schedule a time and place [or the infim-nal hearing to be conducted, which shall be not inore, tthan <br />72 hours (exclusive (afweekendq) of receipt ofthe request for 1-waring. At thea inflormal hearing the Division Director will only <br />consider testimony from you., City perm)nnel involved in the incident that resulted in this Nonce, and otherwitnesses to the <br />incident. The Division Director rnay exchide anyone., anther than yo and those presenting testimony, froin the ink)r-rual hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This P+ otic Exclusion was defivert�d to the person named at the top ofthis Notice at it , (1, c and titne shown abicwelby�� <br />44 <br />. . w_.,,,,.. . <br />. .................................................... . . . --- . . . . . ................... ...... <br />(Sign , re of person issuing/delivering rofice) <br />I hereby acknowledge re ccipt ofthe above Notice on the date arid tirne indicated above. <br />(Signature ofperson being issued the nI(.,6IL,I,.,,,9 <br />While Copy� PvTbhc Workrs GrTn Copy: FiN, Yellow L'cqy: Report Cnp,,a Vink Ccq5y! Rmpiem Go W (.,opy;(Mi,c.er Appeal notivc- <br />