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NOTICE OF RESTRICTION OF USE
<br />and Notice of Right to Appeal
<br />DATL (��'ASE
<br />I OCATfON (PARKJOPEN SPACE)�
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<br />114,une1-ast First Middle DOB: Rac(,°-Sc%
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<br />Res. Addre.,,,s: City sWte Z' Res. [1 V1
<br />CA., -1� 7v'o/
<br />owacpra�
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<br />rider tine authority ofAdministrafive Order No. 58-03-24-Fand Park and Open Space Rule 11-1,005(3).,you are her-iebv
<br />notified that you are prohibited frorn (check box):
<br />fi!7- Entering in or using all City of Fugene parks, open spaces or facilities.
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<br />The basis for th.is Notice of'Restriction of Use is that on a��71S-
<br />r . .............. . . . . , you violated PSeution ...... .. n-ffdiie Park
<br />and Open Space Rules, an . and/or Section 1�X..W7 - _ o f th e F,u gene Code, 1971, and/(-�r
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<br />(Description ofthe violation,)
<br />This restriction of use is effective beginning on and shall remain in effect until 107/7/0 em
<br />—az12-11E_1 ........... . ............
<br />If you enter in or uscany City of Eugene park, open space or facility during the effective period of this Ncrific:e, ycju in,aIy be
<br />arrested and charged with chrninal trespass in (lie second degree.
<br />P urs u ant to Park and Open Space Rule R-1,07 you are entitled to an i n.forTnal laearing to contest this N ofice, A requiesit for an
<br />iriforTnal hearing must be made in writing and filed with the Parks & Open Space Division Director (""the Division
<br />within 48 hours (exclusive ofweekends) 0freCeipt Ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR
<br />97402.
<br />'the Division Directorshall schedu h,,. a firne and place for the informal hearing to The conducted, which ;hall be not rnore than
<br />Td! hours (exclu,,ive (4weekends) ofreceipt ofthe request ftx- hearing, At the informal hearing the F)ivision 1)irector will only
<br />consider testimony from. you., City personnel involved in the incident that resulted in this Notice., and other witniesses k) the
<br />hicident. The Division lDire ctor rnay exclude anyone, other than yAw and diose Presenting tesfinurTny, firornithie hcanririig,
<br />This Notice shall remain in effect pending any, reqnested hearing.
<br />,rtiiis, Notice of" Exclusion was delivered to the person narned at the u.q) of this Noetic:., t the date and time shown abovie, by:
<br />4t' Y f
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<br />(Sijrtumor -orjPUrs-on issuing/delivering, nohccy
<br />I hereby acknuwledgv rieceipt ot"the abcwe Notice on the data: and tjrnc-4wKafe&11boVC.
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<br />S i g4, kure ofj,5'erson bc6ig msucd the acdce)
<br />Wh I I e: is 0 P : I'll RN Wo rk Li GycalAropy: Pile YeBow Cs, p, Prxpoil Crjpy Pink IC opy, Recipeni our Iii Copy: M'fiker Appfna[ nonce +r , iYp417,
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