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N0TK'E OF RESIFIRICTION OF USI <br />and Notice of Right to Appeal <br />CII <br />CASE <br />. . ..................... . . . . . ................. (� . .......... . tas .............. <br />DATL TIML #: <br />LOCATION (PARKA)PEN SPACE)�: EqfLE I L <br />. . . ............... . . <br />Name: Last F iTlft Middle 1f)0BI Race`Se,x <br />17 Aj <br />. ......... . <br />Res, Address: City stite Zip Res,, Phone� W(�rk Pb6i)c� <br />AA`J TF� 17' <br />Under the authority of Administrative Order No. 58-03-24 Fand Park a nd Open Space Rule R-1.005 3- , you a re herelby <br />notified that you are prohihited from (check box)- <br />�d– I Entering in or using all City, of Eugene parks, open spaces or facilities. <br />El <br />The basis forthis Notice (if Restriction of L)se is that on ---------------- .. you violated Section of thic Park, <br />..................... – ------------ . . . ........................... <br />and Open, Space Rules, and/or Section .. . ........ - of the Eugene (.,,ode, 1.971., and./or GIRS ------ 10 wit, you. . . . ......... _ . . ......... <br />............................................... . ........................................................ <br />(Description ofthe violation.) <br />This restriction of use is effective beginning on (A-10 5 1 '.) C– <br />..),I and shall remain in effect until <br />. . . . ....................... --9 —. <br />if you enter in or use any City of Eugene park, ope-n space or facility during the effective period of 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 inforinal hearing to contest this Notice. Arequestforan <br />informal hearing must Ike rnade in °writing and filed with the Parks & Open Space Division Director ("'the Division Ehrieictir.:)r"') <br />within 48 hours (exclusive of weekends) of'receipt ofthis Nq;)fice at the fbIlowing address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place f6r the informal hearing to be C011ducted, which Oiall Ike niot more ffian <br />72 hours (exclusive ofweekends) of receipt. of the request for hearing, At the informal hearinl,, the Division Direic-for will only <br />consider testinnony ftorn yroU, City personnel involved in the incident that resulted in this Notice, and otherwitnessie�s tr.) thic, <br />incident, The Division Director i.nay exclude anyone, other than you and those presenting IeS; fiURMy, (Torn the informal heruring. <br />This Notice shall remain in effect pending any requested hearing, <br />This Notice ol'Exclusion was delivered to the person mirned at the top (-,)f this Nq�Weat the date and tarns; shown albovir by: <br />of"person issuing/defivering nofice,l <br />I hereby acknowledy <br />,!,,e receipt of the above Notice on the dale and time indicated above. <br />- - ------- ------ --- ................ . <br />(SIgnHtUr, person lbeing i:.sucd di c notice) <br />Wintu Ckipy-1 Nbhc Works (:opy. . FAc Ycl{ow f,�'qpyl Felpori (-'f.rPy Pink CkvpyKwiplew t.i0jq1 C'Opy! 0jj'j,C,,jjr s�N ppLr.i <br />kvv, 011,101 <br />