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0-111, <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal ml� <br />D A T1,.: -7 TIME: / 15-0 CASE #:: �) / <br />........ . .... . .......... . . . . ............. . . . ...... . . . . ....... . . . . . ....... .......... .. . . . . .................... . ....... .. .. . ............. . . . ...... <br />LOCATION (PARKjOHN SPACE): IT <br />. ......... . . . . ... .. ............ . . . . . ...... . .......... . —11-1 . .......... . ..... ....................... . . . . ......... . ........ . . .. .. .... ...... <br />Name: Last Micidic D013:! Raco/Se". <br />1-14 Res. Addres- Oty State Zip Res, PW <br />lionir: oIrk Phune: <br />rt� St Zip <br />Underthe authority of Administrative Order No. 58-03-24-Vand Park and pun SpaceRule R-1.005(3), you are hereby <br />notified that you are prohibited rrom (check box). <br />a/ Entering in or using all 0ty ofEugenc parks, open spaces or facilities. <br />The basis for this Notice of'Restriction (.-)f Use is that on ...... . --- 12� you violated Section J: f fthie� Mark <br />r ..... . .... t . . ........... oell) <br />and Open SpaccRules, and/orSection /O ..... .FO. . of the Eugene Code, 1971,and/or oR. S . ............... To wit, you: ....................... <br />. ... <br />. <br />.Of <br />,t M�/)% h <br />M� . .......... ... .. . ........... e . . ....... . . . . ...................... . . <br />(,Description of the violation.) <br />This restriction of use is effective beginning on. cin in effect until . .... . ..... <br />and shall rem -0.kL <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 Space Rule R- 1.074 you are entitled to an informal hearing to contest this Notice. A request k')r an <br />in formal hearing must be made in writing and filed with the Parks & Open Spacc Division Director ("'the Division Director"') <br />within 48 bovirs (exclusive of weekends) of receipt of this Notice at the followii-ig address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a tinie and place for the informal hearing to be conducted, which. shall be not rriore dirm <br />72 hours (exclusive of'weeken.ds) of receipt (if the request for hearing. At the informal hearing the Division Director will only <br />consider testirriony from you, City personnel involved in the incidentthat resulted in this Notice., and other witno�ses to the <br />incident. The Division Director may exclude anyone, otherthan, you and those preseriting testimony, frorn the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Exclusion was delivered to the person named at the top of this Notice-- at ,hale aiidtirnesh(:)ivnab(,.)veby: <br />0� <br />dt�JrL <br />ature of person issuing/delivering notice <br />I hereby acknowledge receipt ofthe above Notice on the date and tirne indicated above, <br />(Signature of person being issued the notice) <br />Whiu- Cupyi Publ,w "h crus Green Cqpy: FdQ. Ycilow Copy� R.qort Copy Pink, r,.'.cpy: Reupient Guld Copy-, Officer AppcM nuc ice <br />........ . . ............................. . ........... ...... ... . .............. . ...- . . . . ...... . ........ . ....................... . . . , I <br />Rev. 04M3 <br />