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NariCE OF RESTRICTION OF USE Afrv, <br />and Notice of Right to Appeal <br />ASE k: Z'S7 <br />DATE: T1 M E: <br />L(')CATION (PARK/0PEPAC' E): <br />............ . . . . . .... . . . .... ........ ---- ---- . ............................................................................................... . . . <br />Name: Last �1 First Middle DOB: Race/Se'' <br />0 <br />CA <br />Ro, Address:: City State Zip Rcs. Phone: Work Phone: <br />12 -Jt-2 <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibit"] from (check box), <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />.................................................................................................................................................................................................................................................................................. . . ............................................................................................................ . ......... . ... . . .. .. . . .. .. . . . . .. .. .. .. . . .................... . ........ . ......... <br />The basis for this Notice of" Restriction of Use is that on ---- r /z you vio[atcd Sie�ctiinn V/ -------------- I <br />and Open Spacc Rules, andior Section - ------- 1-qq ufthe.Eugerie Code, 1971,.and/or ORS To it, yuix:- <br />'1�!� <br />wr 6,15. <br />.-fA,! ......................... - ..................... <br />(Description ofthe violation.) <br />This restriction of use is effective beginning —Jon and shall remain in effect until ............ .... . ...... // ........ ............. . . <br />If you enter in or use any City of Eugene park, open space or fiacility during the effec6ve period of this Notice, you may bir <br />arrested and charged with criminal trespass in the second degree. <br />flursuant 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 inade in writing and filed with the parks, & Open Space Division Director f "the Division F)ireclor <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following addres&; 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a dnic and place f6r the inforinal hearing to, be conducted, which shall be not more than <br />72 hours (eWusive ofweekends) of'receipt ofthie request for hearinp. At the informal hearing the Division Direictior will (inly <br />C011154.11cr Icstir-nony frorn you, City personnel involved in the incident that reRdted in this Notice, and other wnne,;.;;cs to 11ic, <br />incident. rbe Division Director may exclude anyone., other than you and those presenting testiniony, from the inforrrial hearing. <br />'This Notice shall rernain in effect pending any requested hearing. <br />This Notice offxclusion was delivered to the person nained at the top ofthisNode �c eat e --and fime shown aho,%c by� <br />(Signature cpf'person issuanpl/dchvcrhig niofiic,,C)i <br />I hereby ackriowfedVi,e receipt ofthe above Notice on the date and time indicatedabove. <br />(Signature ofl,>erson being issued the nolfice) <br />Whau (,'upyPublic Work,, l[r *Jpy , p. i [U Yr.Ahrx Copy Kupod L:opy Pink iUnp,t: Rc.cipienl (i ld Cnjpy�()ffkeir Appr.-M nodr.c Kw10 `O � <br />