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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />TIME: Q'I <br />6, <br />DATE: CASE <br />. . . . . .............................................. . . . . . . ........ . .............. . . .. . . . .............. . . ... .................................................................. ----- — <br />.. . .... . ................................... . . . . . . . . . . <br />I...,OC'A'-f'ION(PAR,(k/Of'EN,S'IIACE)�� <br />. ....... ...... .. . . ........... . . . . . . . . . . . . . ................................. . . . . . . . . . .... ... .. .. .... ...... ........... <br />.............. <br />Na e: Last Find Middle DOB: Race/SeN, <br />T) i�N <br />-T <br />Res. Addtess� cit, State I ZiD Res. Niune: Work Piwrie� <br />Tp<, <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 />Entering in or using all City of Eugene parks, open spaces or facilities. <br />FIX <br />The basis fair this Notice of'Restriclion. of Llse is that on . .... r you violated Section. <br />oli.the Park <br />and Open Space Rules, and/or Section. of, the Eugene Code, 197 1, and/or OR S Toi wit, yt�)U:_ . .................... <br />ic <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on �6--Zlu and shall remain in effivt until <br />if you enter in or use any City (if Eugene park, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with edminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A, requili f'or all <br />inforinal hearing must be rnade in writing and filed with the Parks & Open Space Division Director ("the Division F),irectior")i <br />within 48 hours (exclusive of weekends) of'receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall sched.u.1c a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of week.ends) of receipt of the request f6r hearing. At the inf6nnal hearing tile Division Director VA ordy <br />ccsnsider testimony from you, City personnel involved in the incident that resulted in this Notice, and wither witnesses 'tca the <br />incident. The Division Director rnay exclude anyone, other than you aud thoise presenting; testhriony, ftom thic, infi.wri-ii,ar.l hiii <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top ofthis Notice at the date, and Bynoe shovi above by� <br />(Sig nature of person issuing/divhviering notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above, <br />(Signattire of person being issued the noticit,,) <br />Whjiic Copy Pubk: Niviii Gili d upy: Filic, Ye.Iluvv Copy; Rqx)rl Copy Pinh Copy; Rom ripienu �(IcAd ACX iererAprepV norice R , 0 P10 � <br />