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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATECJ TJMF� - CASE fl�: 1,2A 3 <br />J_Sgy .... . ........................................................... . ........ . . ..... . __X�..__to . . . ........... . . . ........... . ...... . . ..... .......... <br />LOCATION (PARKJOPEN SR(WE): PA, <br />. . . ...................... I ...................... I.., ............. .............. . . - -------- - <br />Name: La.Q First MW4� D(_ t$: Rlace/Sex: <br />C� I - IRT M PhV to �fj 0 1 &,J/ NAA <br />Res. Addresa: City State Zip Res. I'llone: Work Phone: <br />.......... . . ............. <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R4.005(3), you are hereby <br />notified that you are prohibited from (check box). <br />Vk, Entering in or using all City of Eugene parks, open spaces or facilities. <br />............................................................................................................................................................................................................................................................................................................................................. . . . .. . . . . . ............ .................... . <br />The basis for this Notice of Restriction of Use is that on 0? L <br />-,you violated Section ... 1,_01_() ........ ofthe Park <br />and Open Space Ranks, and/or Se. el ion - Q % 10W of the Eugene Code, 197 1, and/or 0 RS . ­­___'__ . To wit, you�_. <br />............ _9Y&_0.C9_ AiI.j 114-- 4 Gr:: Af_l__ t a, <br />(Description of the viollation.) <br />if you enter in or use any City of Eugene park, open space or facility 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 Open '.;pace Rule 8.4.074 you are entitled to an informal hearing to contest this Notice, A request frbr­ ,,, <br />infornial hearing must be made in writing and filed with the [larks & Open Space Division Director ("'Ilie Division if lag <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address. 1820 Roosevelt, Blvd., Eugene., OR <br />97402. <br />The DiViSiOrl Director shall schedule a time and place for the irifornial hearing to be conducted, which shall be riot imnu than <br />'72 hours (exclusive of weekends)i of receipt of the request for hearing. At the informal hearinjjl, the Divisk)n Director )viH only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notiue, and other witncs,";cr,,, to IN,, <br />incident. The Division Director n iay excludeanyone, other than you and th(.-)se presenting testinlony, from (he infornial heal'i <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Exclucion was delivered to the person named at the top of this Notice at the date and. time shovvn above by: <br />C.". <br />(Signature c'& person issuing/delivering notice) <br />I hereby acknowledge rcccipt of"the, above Notice on the date and time indicated above. <br />(SignaWre of person being issued the ncaiicic) <br />Whim, Cupy� Rublif, Works Grmn C'c�py: He YcHovv Uopy. Rvpv�d (',upy Pink Copy: Ruclpicnr. (Juld (.'opy: (MlIcer \Ppc"M rw6rx Rev. IFLH03' <br />