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NOTICE OF RESTRICTION OF USE F" <br />and Notice of Right to Appeal <br />DATE: TIME: PM <br />... . . ................... .. .................. . . . . . . . . ------------ C'ASE#-, . . . . ................... — . . . .......... ... . . ............ . <br />LOCI ATION (f)ARK/0PEN SPAC1 <br />H Name: Last .11 LrS1 Middle D0W <br />0 S479. 31 <br />Res. Address,_`its S(aw Zip Res,, Phone: WqJrk Phone: <br />Under the authority of Administrative Order No, 58-03-24,,,,x;, nd Park and Open Space Rule R-1.005(3), you Aire hereby <br />notified that you are prohibited frorn (check box): <br />)A 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 j of the Park <br />0- \.5 -- -- - you violated Sectilon <br />and Open Space Rules, and/or Section4s.4 <br />of the Eugene <br />197.1„ a nd/or 0 R S ...... ........ ...... ... . To wit, Yo <br />V <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on antis all remain in effect until...G�im ................. ��7, <br />Ifyou enter in or Use any City, ofEugerre park, open space or facility during the effective period ofthis Notice, you may be <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and (,.)f)cn Space Rule R-1.074 you are entitled to an informal hearing to conte.q this Notice,, A request for an <br />informal hearing must be rnudc 41 Writing and filed With the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends') of receipt of this Notice at the following address1820 Roosevelt, Blvd., Eugene., OR <br />97402. <br />The Division Director shall schedule as time and place for the informal hearing to be conducted, which shall be riot more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infortrial hearing the Division Director will only <br />consider tesait-nony from you., City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infix-irnal hearing. <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 of this Notice at the date and dirne shown above by: <br />(,Signature of person issuing/defivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Whi tc C opy , P k 61 � u ),V ork., umm C,opy� File Ye..flow Copy�Rrpuo Pinl, PCopy, Rcmpient Gaid Copv: Oftkr�',r Appeal nofteRev. ()4 ,01, <br />