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NOTICE OF RESTRICTION OF USE 'zw)�*� tA <br />and Notice of Right to Appeal <br />TIME� Lol' CASE ff: <br />D AT E: () -1 "1 —,) <br />.............. . .. . . . . . ... . ............................. . . . . . . . . . . . .... .................................................................... .. .. .. .. .. .. .. .. .. .. . . . . . .. .. .. .. .. . . . . .. .. .. .. .. .. .. .. . . . . . . . <br />LOC ATION (PARK/OPEN SPAGF�): <br />. ............... <br />...... - ----------- . . . ..... ... . . ..... .... . ....... .. ...... . ...... <br />Name: Last FirstMiddle DOB: Race/s <br />k- 71-1 <br />EA) <br />t Res. Address: City State, Zip Res, llhcine: WOH(PKUW� <br />Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-1,005(3), you are Iherehy <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 (W Restriction of'Uis that onse .55- <br />L) you violatudSection of thti..,� Parl,,,r <br />and Open Space Rules, and/or Section N.1.7 ................... or the Eugene Code, 197 1, and/or ORS T,) 'it "' )rc,I U . . .................. <br />VN- f- �> (-A t -A. - <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect unfil <br />_.w- .... . . ....... <br />Ifyrou enter in or use any City of Eugene park, open space or facility during the effective period of` this Notk.;iu, you rruay be <br />an.-ested 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 rnade inn writing and filed with the Parks & Open Space Division Director (the Division DirtA.Ior-) <br />within 48 hours (exclusive of wcckends) of receipt of this Notice at the following address1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, whiich, shall be not aum,,: 01an <br />72 fiours (exclusive of'weicklends) ofreccipt of the request for hearing. At the infiDirmal hearing the Division Director will only <br />consider testimony from y4:)u, (-'ity personnel involved in the incident that resulted in this Notice, and other, witnesses to the <br />incident. The Division Director rmay exclude anyone, other than you and. those presenting testimony, from the infininal hearing;. <br />This Notice shall remain in effect pending any reqUeNted hearing. <br />This Notice alf Exclusion was delivered to the person named at the top ofthis Notice at the �datc and Hine shown abiuvi�.r� by� <br />T 14-:, <br />........................ .... <br />(Signature of'person issluing/delivering <br />t hereby acknowledge reccipt of the above Notice on thtc date and time indicated above, <br />(Signature of plerson being issued the niotiicie) <br />mLi- (,rcy, Pubfic Wurkr, Giec-ia Uupy: He Ye 110'01 GD�) y: R epc s rt Copy 111A CopyRxopimlil Gold Copy: (lifficeir Appvrull noilk;,,, Kuv, 10440 <br />