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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />#:: <br />DATE: ...................... . .. . . . ........ 'TIME) 132C"ASE ) — ------------------- ............ . . ............. .. ---- <br />LOCATION (PARKJOPEN SPACE);___ <br />. . . . ...................................................................................... ... . ......... <br />.. . <br />. ....................... <br />Manic ast First Midtfle DOB: Race/S <br />> <br />r <br />Res. Address: C°it St s. Phone� Work, llhwnew� <br />YJ <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 prohibited from (check box): <br />Cl <br />The basis for this Notice of Restriction of Use is that on you Violated Sectim'i I ------------------------- _. ir)f illie Park. <br />d Open Space Rules, and/or Section of the Eugene Code, 197 1, anti/or ORIS To wit, yow.. <br />(Description of the violation.) <br />This restriction of use is effective beginning on0&(_1G1, and shall remain in effect until <br />If you enter in or use any City of Eugene park, open space or facility (luring the effective period of this Notice, you nniy 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 informal hearing to contest this Notice. A request for an <br />P <br />informal hearing must be wiriade in writing and filed.withthe parks & Open Space Division Director ("the Division Director—) <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the l'ollowing address1820 Roosevelt, Blvd., Eugene, OR <br />9740,2. <br />The Division Director shall schedule a time and place for the informal hearing to be condUcted, which shall be not morin than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the infonnal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other wifiriesses to the, <br />incident, The Mvision Director may exclude anyone., other than you and those presenting testimony, fironi the informal hearing, <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 this Notice at the date and time shown a.1-)ove Ib!�: <br />(S' i'g, nature- o <br />I hereby acknowledge receipt of the above Notice on the date and time indicated ab4,-)ve. <br />(Signature ofpersoi.-k being issued the noticie) <br />"N h I le ( "I, p� P ab i,. Works Gvccm Copy: Hc YCH()Af JRCP6.)rC ('0PY Pink (..:opy, Recipient GnId CopyXfigcr,-f Aj.)pegO nr,eficv., RqrcPO4/103 <br />