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NOTICE OF RESTRICTION OF USE D <br />and Notice of'Right to Appeal <br />DATI TIME: CASE#: <br />........................ .. . . . . ....... ..... .. ............................................................ . . . . . . . . . . . . . . . . . . . . . <br />................................. . . ... . . . . . . . --- ..... . . .. .... ...................................... . . . . . ................. <br />LOCATION (PAR'K/OPEN Sl'. <br />Laot Middle DOB: Race S X <br />rJ Res- Addrcss: City State Zip Res, Phone:WorPhone: <br />"M <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R 1.005(3), you a re lie reby <br />notified that you are prohibited from (check box)- <br />R� Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 . . . . . ... . ...... . .................................................... — 0 --- ---- . . .............................................................. ....... . <br />The basis for this Notice of'Restriction ofUse is that on you. violated Section U)) . ............................ fthe Park <br />and Open Space Rules, and/or Section of the E'ugene Code, 1971, andJor ORS Tio wit, yolu:: ............ . . <br />).) . .......................... . . <br />(Description ofthe violation.) <br />This restriction of use is effective beginning onand shall until„.._remain in effect ntil <br />— - 61d)t - . <br />If you enter in or use any City of Eugene park, open space or facility during the effective periciid cif this Notilce, you trl,ay be <br />affested and chargicid with criminal trespass in the second degree. <br />Pursuarit to Park. and Open Space Rule It -1.074 you. are entitled to an inforrnal hearing to contest, this Notice. A, request fior un <br />informal hearing mus,t be inade in writing and filed with the Parks & Open Space Division Director ("the Divi,,.siork Dirc;ictic)T”) <br />within 48 hours (eWkNivie of weekeri of receipt of this Notice at the following address: 1820 Roosevelt, Blvd,, Eugene, Olt <br />97402. <br />The Division Director shall schedule a time and place for the infornial hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ofreceipt ofthe request fele; hicaring. At the inforinal hearing the Division Director will only <br />consider testimony ftoin you, City personnel involved irk the incident that resulted in this Iqotice, and (Dither witnesses to the <br />incident. The Division Director inay exclude anyone, other than you and those presenting testimony, ftotyi the inf6rinal I" it <br />This Notice shall retuain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered tri the person norned at the top ofthis Notice at the 4a -and tirrie showrA abcwe Iby: <br />(Sign5u;1re o person issuingAelivering nofice) <br />I hier-eby acknowledge receipt of tliie above Notice on the date and time indicated abovie. <br />(Signature ofperson being issued thy: notice) <br />'Wh 3 1,r ( , q y: Plot)] Ic W k, ri(� Gr= ('rqsy� FflcYellow ( up Y: 9 up rl C opy Pink CopR ei: i p i u n 11 (Rdid Uopy; CM , iceir 4ppeal ncccer¢ R,,-,,, 04,Yr, <br />