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NOTICE OF REs,rRICTION OF USE CACA &Csl,� <br />and Notice of Right to Appeal <br />DATE:o-7 ZxP 11ML CASE lk <br />- ----- ".'.1D .......... . . . . --------------- V7, )151117-122, Q� --------------- <br />LOC,ATION (PARK/0PEN SPACE -_,A <br />ye <br />Naine; Last Middle DOB, <br />ZbJ OU:Z-7�> <br />Res. Address:, City State Zip Reg. Phone: Wmk Phone� <br />Under the authority of, dministrative Order No. 58-03-24-F and Park and Open Space Rule 144.005(3), you are ]hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />'rhe basis for this Notice of Restriction of Use is that on you violated Section the Park <br />and Open Space Rules, and/or See ti on jqo of the Eugene Code, 1971, an(Por ORS To wit, yo ll"r-- ---- <br />? <br />(Description of the violation) 1�\ <br />This restriction of use is effective beginning on and shall remain in effect until ............... 6 ........... 7.Z!?�. <br />. ........... <br />If you enter in or use any City of Eugene park, open space or facility during the etTective period of this Notice, yol..] mdy be <br />arrested arld charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule 8-1.074 you are entitled to an infonnal hearing to contest this Notice., A request tbr an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the revision Director—) <br />within 48 hours (exclusive of'weekends) of'receipt of this Notice at the following address: 1.820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director -,hall schedule a time and place for the ii.)formal hearing to The conducted., which shall be not more than <br />72 hours (exclusive of'weekends) of receipt of the request for hearing. At I[N,, infon-nal hearing the Division Director will only <br />consider testimony Frorn you, City personnel. involved inthe incident that resulted in this Notice, and other witnesscs to the <br />incident, The Division Director may exclude anyone, other than you and those presenting testinjoiny., froyn. the informal huarin,r.. <br />This Notice shall rernain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at alae top of this c an(] time shownabovie by:; <br />. . . . . . . ............... <br />tSignaturc and pe . In issui rrqL <br />e 'Vin(, nollco) <br />I, hereby acknowledge receipt of the above Notice on the date and time in <br />White (.'cppy. PutAc Work GvurjLCOJ)Y: IFily Yelluw (7c.vpy: Repon Copy Pink C'opy: Rccipieiih Gr gra Copy: OfffixrA�[,q7eal uuunce kcv, 04/03 <br />