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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />e 'I <br />'T"IME. <br />DATE.,: wr .................................................... . — CASE .......... <br />NanwLast Firvt e <br />Midd"l' DOB <br />Middle' <br />a 1, <br />f. I f� <br />Res. Addyes&: SILM <br />City e Zip RPh:: <br />es, une <br />S <br />"C'. ff rV <br />Under the authority �of Administrative Order No. 58-03-24-F and Park and Open Space Rule R I. 005(3), yearn are h e°rie by <br />notified that you are prohibited from (check box): <br />V- Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 . . . ..... .. ... . . ..... . . . ............................................................................... . . . . . ........ . ............. . .................. . . . .............. . . . .......................................................... . . ............................... . . . . ................ . . . ....... . . . . .. ................. .. . . . . . .. .. . . . . . 1---- — ------------- - - --- 11 <br />The basis for this Notice of Restriction of Use is that on ,you violated seefiloll I the P"I <br />.,Lnd Open Space Rades, and/or SectionOfthEugene ene (.,,ode, 197 1, and/or GIR,� I . .......... . . . 'l.'�o Wit' <br />0 <br />(Description of the violatkmo <br />This restriction of use is effective beginning on .......... and shall remain in effect until <br />................... zV41 <br />ll'you enter in or use any City ofEugene park, open space or facility during the effective period of anis Notice, you iriI be <br />arrested and charged with criminal trespass in the secc)nd degree. <br />Pursuant to Park and Open Space Rule R-1.074 you are entitled to an informal hearing to contest this Notice. A requiest for- an <br />iriffirnial hearing must be made in writing and filed with the Parks & Open. Spztce, Division Director ("the Division Din.ctor") <br />within 48 hours (exclusive of'weekends) ofreceipt of this Notice at the following address- 1820 Roosevelt, Blvd, Eugene., OR <br />97402. <br />The Division Director shall schedule a time and place f6r the informal hearing to be conducted, which shall 1.)e not more duan. <br />72 ho urs (e xe hisive of weeklends) o freccipt of the request for hearing . At the in fbrrnal hearinp <br />g theDivision Director will only <br />consider testimony t1orri you, City personnel ir)VOlved in the incident that resUlted in this Noticie, and other witnesses to. thi.11 <br />incident. The Division Director may exctudc anyone, other than you and those premniting testimorky, frorn the inforrnM hit"aning. <br />This Notice shall remain in effect pending any requested bearing. <br />'-->t the date and lime shown aloovir by: <br />This Notice of Exclusion vvas delivered to the person named at the top of this Noti <br />......... ------ ........... <br />(S gnatu of person issuing/delivuring nohcc) <br />I hereby ack.nowledge receipt of 11 -ie above Notice on the date and thine indicated , bei~' e. <br />......I . ........ ... ... a - <br />'a - - ....... ...... . ... <br />g I ture of pe scu 1.) ing issued the notice) <br />s <br />I,Vhac, I Public. M(orks Grn.uii (-'cqy� Fik- Ydlow (.opy; R„ aaorl. C'opy Pink rr.:'opyRecipient Gc4d: Uippy, Offir,:uT Aj,,)p: mal noLik:I: Jke,, 04/03 <br />