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LA<64 <br />NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />TIML(,'ASE S 19-tiv,41 <br />............................................................................ <br />LOCATION (PARKJOPEN SPAC,E) <br />Nari= Laqw First Middle L)08: Race Sex: <br />5 <br />�t - ZJ <br />, R, I <br />-IL13 . . ..... <br />Res. Address: Ciily Zip Res. PhOrle: <br />. �,.'ta to I Work Phone: <br />........... . . . . . . . ...... . ............................... <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Opera, Space Rule R-1.005(3), you afire herehv <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice of Restrietion of Use is that (..)n youviolated Section of thie flafl,,, <br />.1.. 1.1.1.....- 1 1 1 ........ .... .... ........... . . . ...................................... . -..- <br />and Open Space Rules, and/or Section f?,, qa— of the Eugene Code, 19"7'1, and/or OR.S To wit, you: <br />. . .. . ........... .,� ........................... z ................... -7 <br />.... ....... . _J44., <br />........ ..... <br />(Description of the violation.) <br />This restriction of use is effective begin ning on -7t,.<—, and %hall remain in eff(Tt unfil <br />If y(rm enter in or use any City cof Eugene park., open space or fhcility during the effective period of phis Notice, yoti rimy be <br />arrested arid charged with criminal trespass in the second degree. <br />Pursuant to Park and 'Open Space Rule R- 1.074 you are entitled to an inforrnal hearingy (o contest this Notice, A request for an <br />infOTTYMI hearing must be made in writi ng and filed w i th the Parks & Open Space Division Di rector ( "ihc Divisic)n Di rec tor ") <br />within 48 hours (exclusive of weekends) of'reccipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Di vi q ion Director sha I I schedule an tir-ne and place for the in fc)rrnal bearing to be cond ucte(.1, which shall be not more: th �a r, <br />72 hours (exclusive ofweekends) of receipt ofthe request for hearing. At the informal hearing the Division Director wiH only <br />consider testimony from you, City persODnel involved in the incident that resulted in this Notice, and. �other witnesses to ffic <br />incident. The Division Direcfi,,br may exclude anyone., other, than you and those presenting testimony, fi,om the informal <br />This Notice shall remain in effect pending any requested hearing. <br />"Mips Mnicc of Exclusion was (ILlive.ried to, the pen -on named at the top oaf this Novice at die date and time shown ablovie by:. <br />. . . ............................................... <br />. ......................... <br />(Signature o F pers4r�)in. <br />I hereby acknowledge receipt of the above Nanticc, on the date and time indicated above. <br />(Signaturie ol'person being i.rssued this" niudcie) <br />W�ijre Copy: Vublic Work.s, Grmm(:"upywipe YdIlow Copy: Repod C`opy Nnk Copy: Reeirnf.nGukl ffflya:t,.r Rt,M'0 J <br />