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j 1 <br />D Iill <br />, 1[1, 11 <br />NOTICE OF RESTRICTION OF USE "Y lj <br />and Notice of Right to Appeal <br />TIME: C,ksr.:: ft. <br />DATE: <br />S,/, S-7— <br />LOCATION (PARK/1011FIN <br />. . ........ . ....... . ........ .... . <br />me: Last First mid(fl-, DOB, <br />R.,, A, acs <br />State"o�' <br />city 'State Zip Res, Phone: lo Plunw. <br />Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R4.005(3), you are hereby <br />nt,itified that you are prohibited from (check box) - <br />Entering in or using all City of Eugene parks, open spaces oi- facilities. <br />............................................................................................................... l ­­­., ­ ................... I .............. . ...... . . . . . . . . . ............... ........... I ......... . . ...... <br />The basis for this Notice of Restriction of Use is durit on you violated Section ................... of I Park <br />and Open Space Rules, and/or Section -067- of the Eugene ode, 1971, and/or ORS 1 '10 wit, you.... .... ...... <br />'5ciojv;(� -rj P/3, -Alt 4V � �— K �'� / fid. -/7 <br />(Description ofthe vir)Iation.) qll <br />This restriction of use is effective beginning on and shall remain in effect until <br />if you enter in or use any (.7ity of Eugene park, open space or facility during the cfTeviv(:,, period of this Notice, you rnay be <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R L(174 you are entitled to an informal hearing to, contest this Notice, A, YvIquest for an <br />informal hearing must be made in writing and filed with [lie Parks & Open Space Division Director ("the Division Directur") <br />within 49 hours (exclusive or weekends) of receip�t of this Notice at the following address. 1820 Roosevelt, ]Blvd., Eugene, Oft <br />97402. <br />The Division Director shal I schedule a time and place for the informal hearing to be coTaducted, which shall be not. toI than <br />72 hotrrs (exclusive of wvekends) ofreecipt of the request for hmiring. At the infi)rTnal hearing the Division Director N,OH only <br />consider testimony frorri you, City personnel involved in the incident that resulted in. this Notict;, and. (,Mher to the <br />iT)CidLnt, The Division Director may exclude anyone, other than you and those presenting testimony, From the inftn'Trud 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 Notic'e' the date and tntie shlownablove by: <br />kctve 4elf .11i n issuing/ dehiver I it I ig no6co <br />I hereby acknowledge receipt ofthe above Notice on, the date and time ind <br />..................................................................... <br />S_ <br />4A <br />'S" le malu C (fl, ilerson bci nonce <br />'er'd") <br />whiaQ Copy: Public woyk" Grc,,.'R'v C�upy, F ip: Y'd1ow copykqwrl' copPink C'opy; Rec�ipient (Jold III ir )ffirroir Apped nn6cc Rev, 04,'W3 <br />