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NOTICE OF RESTRICTION OF SIS'", <br />and Notice of Right to Appeal <br />TIML CAS F <br />.................. . . . . ............. . ............... . . <br />DATE <br />LOCATION (PARK/OPIN SPA(.1"). <br />Nan -ie: Last Middle 1)013r -XI <br />Res: Addmx City State Z1P Res. Phone:: Work H,x)ne: <br />-77 <br />Under the authority of Administrative Order No. 58-03-24 F and Park and Open Space Rule R-1.005�), you are hereti�.%, <br />notified that you are prohibited from (check box) - <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for tl-d s Notice o F Restriction of [Tse is that on You violated. Seeikkan . .......... / .......... the.Park <br />and Open Space Rij les, and/or Section ofthe Eugene Code, 197 1, and/or 0 RS - - - - - - - - -- To it., You ................ <br />aJf3 -- <br />4#9 111%N- <br />. . . . . . . . . ..................................................................................................................... � PIP <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in efFeTt until <br />� -�I— . ... . .... . <br />Ifyou enter in or use any City of Eugene park, open space or facility during the effuctive 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 informal h earing to, contest this N oti1c.. e. Arequestfor an. <br />informal heiaring must be made in writing and filed with the Parks & Open Space Division Director ("tfie Division Director") <br />within 48 hours (exclusive of weekends) (if receipt of this Notice at the fiol low ing address. 1820 Roosevelt, Blvd., Eugerne, OR <br />97402, <br />The Division Director shall schcdulc a time and place for the informal hearing to be conducted, which shall be not rrune than <br />72 hours (exclusive of'weekends) oaf receipt ofthe request for hearing -At the informal hearing the Division Directorwill (.inly <br />consider testimony firorn you, (Ity personnel involved in the incident that resulted in this Notik:,(..1,., and other witnesses to'time <br />i nci doit The Division Di rector tnay exclude anyone, other than you and those presenting testimony, from the inf6rrna I hearing <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Exclusion was dclivered to the person named at the top of this Notic t th��ate and abov�,Ir Y : <br />r,nature ol'person issuing/dulivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and trine indicated. above, <br />(Sigy-nature ofpersori being Issia-eid the <br />'W h i le C opy : N 1! b I i c W 0 r k', Chu,"m 11",c)py, Hk� YvAlk.ov CopyRupon Crop Pink (,'�up: y, Kccipip'ni GcAd Crqlyr-ffhceii Appefl vm.)6ee Rt,,v. if 41'103 <br />