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ii <br />D�j C <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIMH� CASE M: <br />.. . . ... . . . . . ......................... . . . . ........ .... . ...................... .. . ................................................................... . . . . - L—J—J— <br />LOCATION (PAR.K./OPEN SPACE): <br />'M& � -- - - - ---------- -- JP-( ----------- .... ......... . . ....... . . . . . . . . . . . . . ....... ........................................... <br />Name., Last First Middle t )B. <br />1U <br />Re,,,�- A&IM"K 'ity St, te Zip Res. Phone� W.k ii, <br />Under the authority of Administrative Order inn® 58-03-24-F and Park and Open Space Rule R. -I.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />A, Entering in or using all City of Eugene parks, open spaces or facilities. <br />E.1 — .................... . ............ -- - ----- <br />fhe basis fbr this Notice of Restriction of LJse is that on you violated Section ---- - ----- ----------------------- io if the Park <br />and Open Space Rules, and/or Section a of the Eugene Code, 197 1, and/or ORS 1"o wit, yok'r---- <br />li <br />.. . . .......... . . ......... . ................................................ ............................................ ... . ................................................................................... . ................... . . . . . . . . . . . . . .......................................................................................... . . . . . . . ............................. . <br />(Description of the violation.) <br />This restriction of use is effective beginning on�-. and shall remain in effect unfil 6 <br />if you enter in or use any City of'Eugene park, open space or facility during the effective period olf this Notice, you ulay ble <br />arrested and charged with criminat trespass in the second degree. <br />Pursuant to Park and Opert Space Rule R 1 .074 you are entitled to an in formal hearing to contest this Notice, A requiesit for an <br />informal hearing Must be inade in writing and filed with the Parks & (,.)pcn Space Division ItDircetuar ("'the Division Direcitiur"'� <br />within 48 hours (CXClUSiVe Of Weekends) of receipt of this Notice at the Following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97401 <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, whieb shall laic not more 0'san <br />72 hours (exclusive ofveiekends) of'receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice., and Tither witnesses tothe <br />incident. The Division Direc-tor may exclude anyone, other than you and those presenting testimony, frorn the niftirrnal henariirig. <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 data: and time shoo abovie by� <br />(Sik <br />!naftire ot"person issii.iing/dil."bw T'h'k! <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated ab�e. <br />.............. ............. ........................................... . . . . . . . - <br />-------- <br />(Sig ure of person being issu the noticie) <br />Whdc Copy� PiMidw Work,, Gnvc,n Corypy: Filc ViAlow Crppy. IRepvra Copy Nnk Cupy. . Red Lpiui� Guild Copy: Offir.oF Arqmd w6r.r,: Re, Y, W 103 <br />