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NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />DATFI67P.,51 . . . ......................................... . TIME: ".5 C C.ASE, k:
<br />LOCATION (PARK/GVEN Sl?A10E):,fhS_r . ....... .. E �_Yzk .. . . . .......
<br />I .............................. . . . . ............................................. . . . . . . . . . ................... .
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<br />Mane: LastFirs I Mid(llc DOB:
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<br />Res. Address: city State Zip Res. Phone:: Work Pbone:
<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 />P, Entering in or using all City of Eugene parks, open spaces or facilities,
<br />M
<br />The basis for this Notice of Restriction of Use is tbal onxjmj_r_� — ---------- -,,,you violated Seclion], Park
<br />and Open Space Rules, and/cpr Section of the Eugene Code, 19'"71 „ anWor ORS TO wit, K.,6
<br />C c r
<br />_Ll_� . ............. 6 ............. . 9 ......................-------
<br />(Descriptitm of the violation.)
<br />This restriction ofuse is effLTtive beginning on OC "2S. and shall, remain in effect until
<br />If you enter in or use any (. .'ity ofEugene park, open space or facility dutink, the effective period ofthis Notice, you rn,,ay be
<br />arrested and charged with criminal trespass in the second degree.
<br />Pursuant to Park and Open Space Rule R. -I.074 you are entitled to an inf6mial hearing to contest this Notice. A reqUiCS11 f6l, ,an
<br />inforwinal hearing must be made in, writing and filed with the Parks & Open Space Divisk,.)n Director ("the Division Diivictur")
<br />within 4K hours (exchisive of'weekends) of receipt ofthis Notice atthe fi.)IIOWing addrc%s� 1820 Roosievelt, Blvd., Eugene, OR
<br />97402.
<br />The Division Director shall schedule a time and place for the inflonnal hearing to be conducted, +vhich stiAl be not more than
<br />72 hours (exclusive of weekends) of receipt of the request for hearing -At the infbi-mal hearing the Division Director wvill only
<br />consider testimony from you, City personnel involved in the incident that resulted in this Notic(,.-, and othier witnesses to the
<br />incident, The Division D irector may exclude anyone, oth.er than you and those presenting tes fimony, ftio m the rn f6rina I heoiri rjK
<br />This Notice shall remain in effect pending any requested hearing.
<br />This Notice offxclusion was delivered to they personnamed at the top of this Notice ttl,t(,,daLeaind.tirijeshk.,swn,ab�(�)vc.1b),�
<br />,e
<br />. . ..........................
<br />(SignatuMe iln
<br />." ng/dchng notice),
<br />nat
<br />I hereby acknowledge receipt. ofthc abor ;e Notice on the (late and time indicated a
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<br />Sigmature ol"person being, issued the nol.k tin)
<br />White Uc,pyPuhllk; Wurki (heen C'opy� He- VAu"v CopyRr,,,Pc0 iC'0�1!j Pinh, Copy; RecillitnRP, GcAd Cvvpy, Officeir Appeal( noPwe Rev, WrIJ
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