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Nur[CE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: <br />I-OCATION (pARKJORE'N SPA('El): <br />01 <br />Name: Last F i t-st Middle F) 0 B <br />/41 <br />Resp Address: City state Zip Res. Phone: "fit ..)rk Phone: <br />19 <br />i <br />1Jn1der the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />noti red that you a re prohibited fro in (check box): <br />Ud Entering in (or using all City of Eugene parks, open spaces or facilities. <br />. . . . .............. . . . . ................................ <br />you vioWed Section c, Park <br />The basis for this Notice in fRestriction of Use is that on <br />and Open Space Rules, rind/or Section q -- of the Eugene Code, 197 1, arnd/or OR 'To wit, yiou:, <br />. . . .........---- ..... . . . . ............. <br />4)i&MF- Y A-- 0 fr.A-� RI)C� . .......................................................................................... . . <br />. . . .......................................... - - - ----------- . ............... <br />(Description of the violatiori.) <br />This restriction of use is effective beginning on...................... K ai�, and shall remain in effect until <br />Ifyou enter in or use any of Eugene park., open space or facility during the eff�cfive period of this Notice, you tray be <br />arrested and cliarged with criminal trespass in the second dcgTeV. <br />Pursuant to Park anti Open S pace wale R-1.074 074 you aryen.ti ti ed, to, an. informal heari ng to contest this s N otic e. A reque.sa fi..)r an <br />inf6rrna[ hearing inust be naadt,W in writing and Cited with the ["arks & Open Space Division Director ("the Division DireeWr-) <br />within 48 hours (exclusive of'weekends) ofreceipt of this Notice at the following address: 120 Roosevelt, Blvd., Eugene, Olt. <br />97402. <br />The Division Director shall schedule a tiro e and place R)r the informal hearing to be conducted, which shall be riot jrnorc than <br />7.21 hours (exclusive ofmieckends) of'receipt of the request for hearing, At the infinnial 1 -tearing the Division Director M11 only <br />consider testimony ftom you, City per-st-mriel involved in the incident that resulted in this Notice, and other witnesse,s to the <br />incident, The Division Director may exclude anyone, other than you and those preaenting testimony, frown the iii[foryntal hearing <br />This Notice shall remain in effect pending any, requested hearing. <br />I / i <br />This Notice of Fxclusion was defiverol to the pin -son named at the top ofthisNotice at 0, - te and time.shown abw,,eby� <br />'At I <br />. ..... ..... . . . . <br />(Sign,"' re ol'persion issuing/delivering nokice <br />I hereby acknowledge receipt it'Wthe above Notice on the date and dine in ab(.we, <br />(Signature ofperson being issued the notice) <br />W h i te Copy Ruh] i c M A Gn-c-nC'upy: Hic Yeflow Copy! Reped Copy Pink GupyRuwipienir Gcld Copy: 0Cfh:er Appeal nonce R 10 V103 <br />