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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />..... . . . ............ <br />. .......... . ............... . ... .. ...... . . . ...................... . . . ... ........... . <br />TfME: CASE 9: <br />1,0CATION (PARK/01PEN Si" IACE)°_,LXA-)qiF <br />t.J� <br />. . . .......... <br />Naaic:: Last First Middle I)OB:: Race/Sex: <br />itD--Elll) _(e4z1 T - <br />Res. AddressCity State Zip Res., Pbone: Warrk Mione� <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 />notirled that you are prohibitedfro m (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />............................. . . ............................... . . . . ...................................................................... . .......... . . . . . ........ . . .. . ............................ . . <br />The basis for this Notice of'Restriction of'Use is that on. . . . ........ ---, YOU. Violated Section----- oftl-kie Park <br />and Open Space Rules, and/or Section 1-wa-,--, ofthe Eugene Code., 197 1, andJor (.,.)R,.S . . . . . ............................ . I o wit, . . . . . .......... . <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on 5 and shall remain in effect until <br />Ifyou enter in or use any ( "ity of Eu park, open spacc, or faeflity during ffie effectivic, pierioti I this Nofice, yir.�)ia rnray biI <br />arrested and charged with crirninal trespass in the second degree. <br />PUrs ua tit to Park and Open Space Rule R-1,074 you are entitled to an in forrvo I hearing to coutest this N office, At-equestlira. an <br />informal hearing must be rnade in writing and filed with the Parks & Open Space Division Director ("the Division Director"") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following add IOW 1820 Roosevelt, Blvd., Eugene, OR <br />97402® <br />The Division Director shall schedule a fin-ic and place for the informal hearing to be conducted, a0k;h shall be not niorcIfiart <br />72 hours (exclusive cif'weekends) ofreceipt of the request fIor hearing. At the infi)rmai ]hearing thef)ivision Director wiH only <br />con,sider Lestimony floor you, City personnel involved in the incident th3t resu[tcd in flwk, Notice., and other witneI.,"Iscs, to the <br />incident. The Division Director inay exclude anyone, other that) you and those presenting testirmany, ftorn the informal ht-,-,aring <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered tar the person riHmed at the top ot'this, Notice at the wand time shown above by,, <br />......................... <br />. ........ . . ... .. .... . <br />g at )e so ung/dclivering wflce) <br />I herehy acknowledge receipt oftlic, above Notice on the date and tirne indicated above <br />. . .......................... <br />(Sig a/rexo)lf"pq.,��tng�l�ssue(ithier�ollilce) <br />While I PubNII WwkG'revul Ccpc Myeflvw CopyRepoli (..'opy Wink Copy: Rccipient' GoIld I 01Mxr App=J noriu IRR,, (),V103 <br />