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NOTICEOFRdT. RICTIONOFUSE <br />and Notice of Right to Appeal <br />. . . ....................... . . . <br />DATL TIME- CASE <br />........... �.. . . .. . ........ . . . . . .............. <br />LOCATION (PARK/OPEN SFIA(,,E): <br />"I . ..................... . . . . . ................... . ............................... . . . . . . . ............ . ........ <br />. . . . . ........... . . ........... <br />Maim:: Last First Middlc D(A U ('C/sc <br />. . . .. . ......... <br />�7- <br />L..� Res. Address,� CilyS Ip Uplu.,Jkle: WWk IIhcn-w:: <br />at <br />. .................. <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R -L(105(3), you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open spaces or- facilities. <br />. . ..... . ......... . ........................................... .. ..... . . . . . .............. I ............................................. . ......... . . ...... . ................................................................ --- ... . . .... .................... <br />The basis for this Notice of'Riestriction of Use is that on 19F�.you violate(J Section ­ . ............ Of thf,'� ParIc <br />and Open Space Rules, and/or Section , DNCV ot'the Eugene C. 1971, and/or ORS. To wit, yoll-r- <br />(Descripfion of theviotation.) <br />This restriction of use is efFtivr Icirnrrirrg on and shall iremain in effect until <br />. . ................ . ........... . <br />Ifyou enter in or use any City of Eugme park, open space or facility during the eff ctive period of" this Nofice, you inay bic� <br />arrested and charged with crin-drial trespass in the second degree, <br />Pursuant to Park and Of.wn Space Rule R-1,074 you are entitled to an informal hearing to contest this Notice. A request fbi­ arn <br />int'ormal hearing must be made inwriting and filed with the Parks & Open Space Division Director ("the Divis4.in Dir eictior") <br />within 48 hours (exc hisive of'weekends') of'receipt of this Nc)tice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedt,& a time and place (br the informal hearing to [)e conducted, which shall be not more Hian <br />72 hours (exetusive of'weekends) of receipt of the request for hearing, At the in1brinal hearing the Divisi.i..'m Director wiii only <br />consider testimony [lyom you, City personnel involved in the incident that resulted in this Notice, and other wiIncrssc,,,s tri the <br />incident, "I"he DivisionDireictormay exclude anyone, other than you and those presenting testimony, rrcwn the infi:)rrna[ hc.,,aring <br />This Notice shall remain in effect pending any requested hearing. <br />'rhis Notice of.ExcWsion was delivered to the person named at the top of this N c"2 an the date and time shown above hyo : <br />rnZ <br />.......... . . ......... ....... ..... I ..... . ....... <br />[Signature of persue nofiee) <br />I hereby acknoMedgv rt-ueipt ofthe above Notice on the date and time indicated above, <br />(Signature of pennon being issued the <br />Whar� ir.`cppy, PubNc worUGreen file Yellow Cfipy� Rpur� Cup y Pink iFcrtryRvf� ipicint (ioki Uojp,,,,: ip fflf.r.rAppe,,d ntmirce R 04,03 <br />