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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME 3 <br />" IE #: <br />(AS <br />1� Y <br />. ...................... . . ........ . . ............ . — . . ..................................... . . . .... <br />LOCATION (PARKIOPEN SPACE):_,_ 40L Kic, <br />. .. . ........ . ��!s . .... . <br />Name� LwA First Middle DOB� Rice/lxe: <br />�V <br />Res, Address: City State Zip Res, pllone: Work Pfume: <br />A <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(13), you are tits -ehy <br />notified that you are prohlbited from (check box,), <br />Entering in or using all City of Eugene parks, open %paces or facilities. <br />101 <br />I W''M <br />The basis for this Notice of'Restriction of Use is that onyou vi-otated —Section t -h 'c� P a rh, <br />_ �/ o -A5 - ------ <br />and Open Space Rul.es, and/or Section of the Eugene Code, 1971, andk.)r ORS - ------- - To•wit, young .... . . . . . . . .................... <br />... ............................................... ---&, &I/. ...... . 64WI.." . ............ ___­ . . ............................................................................................................... <br />(Description of the violation.) 4.�/ 4,�, -ct until <br />This restriction (of ase is, effective he on ............... and shall remain in effe <br />..... ....... . <br />If you enter in or use, any City of'Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park. and O.:)en Space Rule R-1.074 you are entitled. to art informal hearing to contest this Notice. A reqtiest 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 ot"weekends) of receipt of this Notice at the fiollo%ring address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to The conductiF°d, vzhici-i shall be not more, than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing Division Director will only <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notiec, and other witriessirs to the <br />incident, Ilic Division Director may exclude anyone, other than you and those presenting teslirriony, firorn the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice ofExclusion was delivered to the person riamed at the top ofthis Notice at the da ancl tinie shown ablove by., <br />C <br />U� <br />................ ... ... .... . <br />(Sig 9-tW,.-e of person issulng/dulivenng, notic c') <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature orperson, being issued the noticieln <br />Whae, C,L)py! PuNio, nVoOu Gfevn Copy: File YFAlow CopR,purk 11,`,upy P4ik C'opy: Recipieoi�it Cidd Copy Offkcr AppcO mA%x kvn 04/03 <br />