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70 <br />Nar[CE OF REs,rRICTION OF USE <br />and Notice of Right to Appeal <br />(6 jo <br />D ATE TIME: CASE ft� <br />LOCATION (PARK/OPEN SPA,C' <br />J 44 <br />Name: Last First Middle DOD, <br />13 Al <br />Res, Addrcss° City State Zip Res. Phone: Work Phow� <br />. . . .............. . <br />Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-1.005(3),you are herr by <br />notified that you are prohibited from (check box.): <br />Entering in or using all City of Eugene parks, open spaces or facilities® <br />The basis fbr this Notice of'Restriction of' Use is that ('Pri C) 11 you vio, rated Section ofthe Parlu:. <br />an(] Open Space Rules, and/or Section of the Ellrene Code, 1971,and/or ORS-- I To it, yiotir— <br />C' --------------------- — <br />. .. ...................................................................................................... . ... . .... ....... . . . . . ......... . . ..................................... . <br />(Description ofthe violatiom) <br />This restriction of use is effcvtive beginning on G <br />and shall remain in effect until '�, <br />.............. . . . ...... . 3 ..... ....... <br />if you enter in or use any City of Eugene park, open space or facility during the effective pericpd of this Notice-, you may 1roe <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R.-4.074 you are entitled to an infornial hearing to contest, this Notice. A request, J.or an <br />inforinal hearing must be made in writing and filed with the Parks & Open Space Division Director- ("the Division Direic.,,bor") <br />within 49 hours (exclusive of,weckends) of receipt ol'this Notice at the following address:: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the inforrual hearing to be conducted, which shall be riot more thari <br />72 hours (exclusive ofweekends) of receipt ofthe request fbr hearing. At the infornial hearing the Divisiurt Direaor wvfll only <br />consider testimorty fh�)rrt you., City personnel involved in the incident that resulted in this Notice, and other witnesses I'D the, <br />incident, The 1) ivi sion Director rnay exclude anyone, other than. you and those presenting Testimony, from the III earing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to, the, person named at the top of tIiis1.'To%' eat the clafe—,ind time shiown above by: <br />. . ...................... . ..... ..... .. . ......................... . . . .. . ........... . . . .................................................................................. . <br />(Sig ature of person issuing/delivering no6cu) <br />ly-11 tu <br />I hereby acknowledge receipt ol'the above Notice on the data: and time indicat1d above. <br />fpciiic)n bcllng issued the nonce) <br />Wh r10 Cojrk Public WcA,, Green("opyF& Y el I o WV cor, yIRS vort C;[PPY pljltl �CupRxvipvnil (kyl d Cirp1py; (p flkcil APTXRil noll k.:v- Pou-,% I.Ws) <br />