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NOTICE OF RESTRICTION OF USE �M515�4,w <br />and Notice of Right to Appeal <br />DATE:: T1 M F; /Asr-> CASE <br />............ . . . .. . ... . .... . ... . ...... . . ................... --- � I I ....... --------- ...... .. ....... . . . <br />I-OCATION i PARK/0 PEN SPAC F)i <br />............. <br />- - ----------- <br />Narne: Last First 'Y11 CIIIIOMiddy DOB� Raeo,'Sex - <br />-7 �95,0 <br />1.4 Res. Address; city State Zip, Res, Phone. Work Phone� <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 />)K Entering in or using all City of Eugene parks, open spaces or facitities. <br />El <br />The basis fi)r this Notice of Restriction cif Use is that on 0-7 V? �Jf the Paric <br />you violated Section <br />and Open Space Rules, and/or Section of the [`ugene Code, 197 L, an&ur ORS 'ro wit, yotc <br />. . ............ . <br />CWA' <br />(Description of the vionation. ) <br />This restriction of use is effective beginning on IT h? -,, and shall remain, in effect untH <br />Ifyou enter in or use any City of Eugene park, open space or facility during the cffective period cif this Notice, you may 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 for an <br />informal hearing must be made in 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 address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a timc and place for the inti, n -nal hearing to be conducted, which shall be not trlorcthan <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the in tbrimal hearing the Division Director will only <br />consider testimony 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 infi.)rmal hearing, <br />This olice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top cif this Notice at the date and time shown above by: <br />.......................... . . I'll . .. ... .. ..... . <br />(Signature ol'person issuing,/delivering notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated above. <br />(Signature of person being issued the notic), <br />White CopyPublic 'Norks Grecm Copy: File Vc,,Now Gf.)py: Re port Copy Nulk Copy: Fecipiew. Gkjkl Copy: 01ficier Apptil rwrJvu lk,�,v, (W03 <br />