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NOTICE OF RESTRICTION OF USE <br />and Notice of [tight to Appeal <br />DATE, TIME: �CASE #': 17 <br />................. ... (6) 7-9 <br />LOCATION (PARK/0PEN SPACI.�") <br />U <br />r,T- fl"�A(- &O(Acc: <br />.......... -2 <br />Middle D013:� <br />City I State I Zil[.) <br />0 6k S <br />Res. flhoneI Work llhamie: <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 />)1;61 Entering in or using all City of Eugene Parks, open spaces or facilities. <br />A <br />The basis for this Notice of Restriction. of Use is that on .0 I -L 'D / D of the Park CocRUL5 y1ou violated Section <br />Open Space Rules, and/or Section_q�gqb of the Eugene Code, 197t, andfair ()]i To, wit, you:.... <br />(Description oaf the violation.) <br />This restriction of use is effective beginning on C)b dL& and shall remain in effect until <br />....... . . . .. . . . . .. . . . ........................................ . . . . . ........... <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Noticie, you may bie <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule -1.f174 you are entitled to an inforrinal hearing to contest this Notice. A request fror art <br />informal hearing must be made in writing and filed with the Parks & OIien Space Division Director (i Division Diricvor-) <br />within 48 hours (exc[.USiVe of weekends) ofreceipt of this Notice at the following addtcss1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place 1'(.,)r the informal hearing to, be conducted, which shall be not Inore lhan <br />72 hours (exclusive of weekends) of receipt of the request for hearing, At the itiftjinnal hicaring the Division Director will ainly <br />consider testimony fro rn you, ( . ' lity personnel involved in the incident that resulted in this Noficca, and other witnesses to 'th, <br />incident. 'ne Division Director may exclude anyone., other than you and those presenting testimony, fiom the informal, hicaring <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person narned at the top ofthis Notice at the date and tirne sh(,)wn above by: <br />nn,-------- --- I ----- - ---- <br />t'I , 11rL ot'person issuing/defivering noticcl <br />I hereby acknowledge receipt of" the above Notice on the date and tirne indicated above. <br />------- - ----- <br />(Signature of'rierson being issued the notice) <br />White Cupy Publiv Worb (.4uun CopyFk YrAIrcry Copy: Reporl C'opy Pink Ciopy: Rmplum GoW Copiy�:r,"HIkeu Appe�ul nofic;e Rev, 04,T0 <br />