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NOTICE OF RESTRICTION OF USEloll <br />and Notice of Right to Appeal <br />DATE� 0-1 Is"i j <br />........ . . . ............. . . . - ..S ........... . . I . . ........... TIME: . ............ . . . . . . CASE .......... . 71 1 . . . . . . ................... .. .. . . <br />LOCATION it SRACE'): . ........................ <br />. . . .............. . . . . <br />j- Name:: Last Fin't Middle 1 -)OB: Racc/'Sex <br />............ <br />Res. Addres,4: state Zip Res. F)Lone:: Work, flhonc� <br />Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-1.005(3), <br />you are hiereby <br />notilled that you are prohibited from (check box)- <br />-01 Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 ............... . ......................... ........................................... . . . . . . . ... . ...................................................................... . .......... . . . . . . . . -. . ..... --.- ........ . . <br />The basis for this Notice of Restt�icfiom of Use is that on y('),u violated Section uey) f the Park <br />and Open Space Rules, and/or Section '�,C ...... . .. ........... ...... <br />__. -j of Eugene Code, 197 1, and/or ORS To wit, ylc)ljl!! <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on <br />L—, and shall remain in effect, until <br />If you enter in or• use any City ofEugene park, open space or facility during the effective period of this Notice, you may ble <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and Open Space Rule 1t-1.0174 you are entitled ter an iffl.'Ormal hearing to contest this Noiice. A request fiiran <br />infc)rrnal healing must be made in 'WTiting and filed with the Varks. & Open Space Division Dii-ex-,tcn.- ("the Division Director") <br />within 48 hours (exclusive of'weekeiids) ofreceipt of this Notice at the following address:: 1820 Roosevelt., Blvd., Emgenc, OR <br />97402. <br />The Division Director shall schedule a time and place for the inf6mial hearing to be conducted., Which shall be not more lliall <br />72 hours (exclusive of weekends) of reccipt of the request for hearing, At the informal 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 Direcux- may exclude anyone, other than you and those presenting testirnony, friorn the infbrynal hearing'. <br />This Notice shall remain in effect pending any requested hearing. <br />This Noticc ol'Excktsiun was delivered to the person narned at the top of this Notice at the datcand tinte shown abiuve by� <br />40 q . ........ .. .. <br />. . ................ . . ........ <br />(Signature of"persion <br />I hereby acknowledge receipt of the above Notice on the date and titne indicated above, <br />(Signature of persoin being issued the noticier) <br />AN te C'opy: Pu Roc W o r k s Un�.ert Copw File Ye1kriw Copy; Rqxm Copy Pink Copy kupjoll. OrAd Copy� Officeir Rr,,,,% 04 dO 1, <br />