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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />............m.. DA,rE TIME: CASE /S, <br />Narne: Last First Middle DOB� Race/se <br />�L Res, Address: City State Zip Res. Phone:: Work Pltqme� <br />Under the authority oft dln inistrative Order No, 58-0324-F and Park and Open Space Rule R4.005(3), you are herehv <br />notified that you are prohibited from (check box): <br />s that on the, park <br />The basis for this Notice of'Restriction of Use j, 40 1 <br />you violated Section_ <br />- , )A <br />and Open Space Rults, and/or Section t/dQQ of the Fu gene Code, 1971, and/or OR.S To Wit, You: ................................. <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in Week until —Va rr <br />If you enter in or rise any City ofEugene park, open space or lacility during the effective period of this Notice, you rnay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and( )pen Space Rk,fle R-1.074 you are entitled to an informal hearing to contest this Notice, A, request fri,)r rota <br />infi)rmal hearing must be made in writing and filed with the Parks & Opezi[ Space Division Director- ("the Division if ire. <br />within 48 hours (exclusive of Nveekends) ofreceipt ofthis Notice at the following address- 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall tie not ntot-e than <br />'72 hours (exclusive of weekends) of receipt (if the requesti-or hearing. At the inf6rnial hearing the Division Directur will only <br />consider testimony from you, ('try personnel involved in the incident that resulted in this Notice, and other w4nesses to the <br />incident. Ttie Division Director may exclude anyone, other than you and those presentinp <br />.,, testinniony, frorn the inl'brinal hicaling'. <br />This Notice shall remain in effect pending any requested hearing. <br />'Chis Notice o1 Exclusion was delivered to the person narned at the top of this N� otice at ie to and tity-te shown above� t-.uY; <br />..................... <br />V 06 <br />............................ <br />(Signature of'person issuing/delivering noflce,� <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />(Signature oflperson being issued the notice) <br />White Copy: Public Works 6rv,(.mC.'opy: He Ydlcw Copy! Repoul Copy Pmk Ccppy Pi,,,:ijmcnL (3uld ('apy:: ftffiver Apperall nr,,Irirce NiN <br />