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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE�IPTIME: CASE#� <br />. . . . . ................... . ------------- .. .. ....... ..... - <br />-2: ............ .. <br />LO("ATION (111ARKA)PEN SPACE):: MIHJAI.11?". "T&OC'A C-il-,,k h'i(s/ <br />Namc. Last First Middle DOB: R 1C[�/sCXL:"j <br />FE <br />........... . ..... <br />LLJ Res. Addireswi city State Zip Res, Phone: wod� ll lonc: <br />A0 'I F5 0 <br />Underthe authorityof Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-4,005(3),your are hereby <br />notified tha( you are prohibited from (check box): <br />I <br />Loitering in or using all City, of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of'Restriction of Use is that on --O on '�., 110 �/ ii('I' of thc� Park <br />yoliti violated Seict - ------------ -- <br />and Open Space Rules, and/or S�eCiio[t of the Eugene Code, 1971, and/or ORS � To W�t, you: <br />. . . ..................... - .... <br />'-V,;1(17 <br />(Description of1he vio[aticin,) <br />This restriction of use is effective beginning on ..............C. -L73 and shall remain in effect until <br />..... ----- <br />�j Z <br />If you enter in or use any City of Eu park, open space or faicifiry during the clTective period oil" this Notice, you may be <br />arrested 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 inrormal hearing to cointest this Notice. A request fror a, <br />infornial frearing must be wade in writing and filed with The Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of'receipt of thig Notice at the following address1820 Roosevelt, BI'vid., Eugene, OR <br />97402. <br />The Division Director shalll schedule a time and place for the informal hearing to be conducted, which shall be nioit more Than <br />72 hours (exclusive of weekends) of receipt of the request tbr hearing. At the informal hearing ffie Division Director wffl only <br />consider testimony Fromyou, ( ' try persimnel involved hi the incident that resulted in this Notice, and other vvitnesrr-pies to the <br />incident, The Division Director inay exclude anyone., other than you and those presentirig testimony, trona the informal hearing, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion waq delivered to the person named at the top of this; N4.)1je'e' at the (late and time shlown. al. -)ova Ibyt� <br />I hereby acknowledge receipt of the above Notice on the date and time <br />ol'person issuing/delivering noticc.) <br />above. <br />vifpersiki being issued the <br />Whirc Copy: Public WorksGn,�.n Copy: N11k, Yel I om Gap y � Rcpfi Copy Pink Cupy: Rvv[pjeniCold Copy Dffjrrr:r Apperrd i R,, v, lyl /or <br />