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NOTICE OF RESTRICTION OF USE <br />and Notice (if Right to Appeal <br />�.m"TIMECASE ff� DATE: � . . . . . . . . . . .. .. .......................... . . <br />� .0(j9---1&15- <br />k. ks <br />LOCATION (PARK/OPF"N SRA('.1E): <br />. . . . ......... <br />Name: Last First Middle DOB: Racersev <br />LT 6 U - <br />Res. Address: City State Zilp Res. PhoneWork Phone: <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 />0 Entering in or using all City of Eugene parks, open spaces or facilities. <br />. .. . . . ..................................................................................... .. . . . . ....... . ..... . . . ...... ......... . . .. .................... <br />The basis for this Notice of.R.c:striction of Use is that on. 0(j J& (.5- you violated Section thie Park, <br />and Open Space Rules, an(Vor Section. <br />(Description of the violation.) <br />of the Eugene Code, 197 1, and/or ORS ... . . . . ....................................... o VV n, Y011-1 . . . . .................. <br />This restriction of use is effective beginning on AWILL-5--, ands all remain in effect until 0,21-� <br />if you enter in or use any City of Eugene park, open space or facility during the effective period ofthis Notice, yit.)u may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R-1.07 You are entitled to an in for-nial hearing to contest this Notice..A req tiest l Or all <br />inf'ormal hearing rnust be made in, writing and riled with the Parks & Open Space Division Director ("the DiNrision Director") <br />within 48 hours (exclusive ol'weekends) of receipt reef this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a flyne and place for the infon nal hearing to be conducted, which shall be not more ffi,,:In <br />72 hours (exclusive of'weekends) of receipt of the request for hearing, At the inforrnal bearing the Division Director wfli only <br />consider' WStirn(PDY from you, City personnel involved in the incident that re..swlted in this Nofloc, and oither wiitnesses to the <br />incidero. The Division Director may exclude anyone, other than you and those presenting tcstinumy, frorn thc,. inforinal hearing. <br />This Notice shall remain in effect pending any requested bearing, <br />This Notice of'Exclusion was delivered to the person named at the top of this N ' at the date, and time %hicunvrn above by: <br />3qS .... . ......... . <br />(Sign" urc afliurson issuing/del i veripKnot ice) <br />— r nlc�16cr,� <br />I hereby acknowledge receipt of the above Notice on the date and time indicated ab e. <br />..... ................... . . . . ......... <br />`igna ire o p rs i heing issued the noticc <br />, /""rt ) ,, � , /� <br />White Copyflubk Wud,. Green CopyFite Yroflcm CopyRepWt Cqprvg Pink (-'rypy� Rem-,ipiiant Guld Cropy Officc"f Api:Moll notic-C. Rev, 6,8;`6.1 <br />