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C <br />NOTICE OF REST RICTION OF USE <br />and Notice of Right to Appeal <br />DATE: TIME: S CASEA�� J5- 3 . . . .. .................... . <br />.... . ...... . . ............. <br />L0(.%AkTlON (PARK/OPEN SPACl (&S.77' . ...................... . <br />Namc; Laxt First Middle D0B- Raee/so�v <br />o <br />Re,,,. Addregs: City State Zip Res. Phone: Woyk Phone� <br />Under the authority ofAdministrative Order No. 58-03-24-F and Park and Open Space Rule 114,005(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 />0 . .. . . . ...... . . ......... -- ....... . . . . . . ............. . -'- . .. . . . . . . . . .......................................... . . .. . <br />The basis for this Notice i)f es;tric°tion of Use is that on'you <br />)(.:Wth.e Park <br />and Open Space Rules, and/or Section 9, MO of the Eugene Code, 197 1, and/or ORS Tern it, you: <br />1-'r' AC <br />(Description of the violation. <br />This restriction of use is effective beginning on and shall remain in effect untfl *ZW <br />lryou enter in or use any City of'Lana. gene park, Opens , ou rnay bie- <br />pace or facifity during thic effective periold ofthis Notice y <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. Are quc�stftiran <br />informal hearing inust be made in writing and filed with the Parks & Open Space Division Director ("the Division Dirvctor") <br />within 48 hours (exclusive of weekends) of receipt ofthis Notice at the f6llowing address- 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the infornial hearing to be conducted, which shall be not inore than <br />72 hours (exclusive of weekends) orreceipt of the, request for hearing. At the informal hearing the Division Director ).will only <br />consider testier c) ftom you, City personnel involved in the incident that resulted in this Notice, and other witnesses ti(..) ffie <br />i nci dent. The Division Director may exclude anyone, other than yarns and those presenting testi rriony., trrom the infori nal hmir ing <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion. was delivered to the person narried at the top ofthis Noticeat the, dateand '-Vric shcuwn. abovt�.�.� by: <br />.. . ........ . . ......... . . . . . . .................. . ..... .. . . . . ....... <br />(Signature of person issuirig/delivening nolwie) <br />I hereby ackno)Mcdge receipt of the above Notice on the date and time indicated above. <br />. .................................... . . . - ----- <br />(Signature of person heing, issued the notice) <br />M4��. Copy Pubfic WorloGircpn(up y: Ric, Yr.'Row Copy Repon C:upy Pink Copy: Recupif--nh Goilal Copy Officer Ap peall inrkiWve Rr-'V' 1114WO <br />