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NOTICE OF RESTRICTION OFUSE <br />and Notice of Right to Appeal <br />5TiME: ASE #: 43 <br />DATE :) ?I <br />LOCATION (PARX/0PFN SPACE) <br />. . . ..................... . . . ................................ . .... . . . . . .................... . . <br />Narrje: Last Middh: D(4�13' <br />�Al <br />R,cs. Address: city, State Zip Riv.s. PhunL� wVoirk Phone: <br />A <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-11,005(3), you are hereby <br />notified that you are prohibited from (check box) - <br />Entering in or using all ("Ity of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice flsirrct.iur of Use is that on yot.i violated Section IV ci 0&!,,�fhir Park <br />. .................. <br />and Open Space Rules, and/or Section of the Eugene Code, 197 1., and/or ORS To will, <br />.. ...................................... . . . . . . ................... I ........... ... . . . . . . . ................... <br />(Description of tire violation.) <br />This restriction, of use is effective beginning on --71 -1, and %hall remain in effect until tol islt-.5 <br />If you enter in or use any. City of Eugene park, open space or facility during the effective period t,'jifithis Notice., you rrtray be <br />arrested and charged with criMin.',fl trespass in the second degree, <br />Pursuant to Park and, Open Space Rule R-1.074 you are entitled to an inform al heztring to contest this Notice, krequen,;tft'aan <br />inforrnal hearing niust be made in writingand filed with the Parks & Open Space Diviskin Director q -the [,)ivision f')irector <br />within 48 hours (exclusive of weekends) of rcceipt of this Notice at the following addrcss:: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Di vi sion Director shall schedule a timet: and p lace for the in for-nial h caring to be conducted, w h i e h s hal I be not more tha n <br />72 hours ('e clu s'i'v°e ofweekends) of receipt of the request for hearing. At the informal hearing the Division Director will offly <br />consider testimony frorri you, City persoTHICI involved in the incident that resulted in this Notice, and uauth.er witnesses, tic) thf,, <br />incident. The Division Director may exclude anyone, otherthan you and those presenting I�cstirnony"' ftorrlitj-'we hie'aring. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was deliviered to the person named m the top of this Notice at date and time si�iown abovi�:,,, by�� <br />I <br />. ................ ................. .. . . ......... . <br />(Signature of'person issuing /defivuring notice) <br />I hereby acknowledpz <br />,e receipt of the above Notice on the date and time indicated above. <br />(Signature oflpirrson bifr,,ing issule.d the noifiicc-) <br />Mijw Cory Puhliu 'Work, Girvcn(.:opyHe Yel kr'aI K-upy, Rurml, COPY Pink. Copy: Rocipivriil Gvcdd Cf..�py- Offic,,,.r AppL411 Kcw% Cr*110 6 <br />