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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME� <br />1, CASE fi�: C.) <br />. . . .............. . . . . . . . . . . ........ . .................. --------- .... ......................... . . ..................................................... ..................................... . ....... . . . <br />LOCATION WARK/011EN SPACE): <br />......... .. . . . . . ...... . ........................... . ..... .. ... . . . ......................................................... . . . . . . . . . .. .. .................. <br />Naive; Last First Middic DOB: RacO;ex-, <br />H.es. Address. city State Zip Res, Plio�ne� W ork, P L <br />Z mLe- <br />Under the authority of Administrative Order No.58-03-24-Fand Park and Open Space Rule R-1.005(3)., you are hereby <br />notified that you are prohibited from (check box): <br />Ir Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restriction of Use is that on 'you violatedSection J-6\L(I(ilol-the Park <br />- ------------ - <br />and Open Space Rules, and/or Section of the Eugene Code, 197 1, arid/or ORS To wit, yoIX:....... .......... <br />(Description ofthe violation.) <br />This restriction or use is effective beginning on0,17Nndhll iifftti <br />shall remain n effect until. (S4 t (IN 1� <br />—6L� . . ...... . . .............................. . . . <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you rnay he <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and Open Space pule R -L.074 you are entitled to an informal hearing to, contest this Notice. A request for an <br />informal hearing must be niade in writing and filed with the Parks & Open Space Division Director ("'the Division Director-) <br />within 48 hours (exclusive of weekends) of receilit of this Notice at the following address1820 Roosevelt, Blvd., Eugene, OR <br />97401 <br />The Division Director shall schedule a tuner and place for the informal hearing to be conducted, which shall be not rnoric, Chart <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testirriciny ftorn yciu, City personnel involved in the incident that resulted in this Notice, and, other witnesses to the <br />hic ident. The Div ision Director may, ex elude anyone, other than you and those presenting testimony;', ftorn the i n fori-rial Ii caring <br />This Notice shall remain in effect pending any requested hearing. <br />'chis Notice off'71N,cIusion was delivered to the person narnied at the top ofthis Notice at the da ic and Orne shown above ty: <br />. . . . . ..... ...... ........ . . . . . <br />(Signature ofpemon issuing/delivering, nutiLe) <br />I hereby acknowledge receipt ofthe above Notice on the dateand titne indicated above, <br />. . . ................ .. ....... . . . . . . . 11 ix -,9 . . . . . . ......... ... .. .. .. .. ... .. .. . . . ..... . . .. ........................ <br />(Signature of persf,.)nbeing issued the notice) <br />White Lbp) � Pubhu, WwIL, Gir��cn rr.',,jpy: F�h: VO k � V Cop Y! Rq�Qrl. Cupv Pink. (-'opy� Rec,�Ipieint Golid Copy: (r)rfkx,,r App�,:;d in�iroiluvr,., Rrev, Wgr)3 <br />