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LOCATION (PARKiOPEN PACEXACII,ITY): Echo (Hollow Pool <br />Name: Last First Middle DOB: Race /Sex: <br />LL <br />Fells Jeff <br />Sept. 11, 1444 M <br />Ties. ,address: city State Zip Ides. Phone: Work Phone: <br />377 W. 8" 1+314 Eugene <br />OR 47401 6E6 -3576 none <br />Under the authority of Administrative Order No. 58-07-02-F and Park and Open Space Rule R-1.005(3), <br />hereby notified that you are prohibited from (check box): I <br />The basis for this Notice of Restriction of Use is that on March 7, 2013, you violated Section 1.0 14 of the Park and Open <br />This restriction of use is effective beginning can March 1 , 2013, send shall remain in effect until March 14, 2014. <br />If Kota enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may <br />be arrested and charged with criminal trespass in the second degree. <br />informal Pursuant to Park and Open Space Rule R- 1.075 you are entitled to an informal hearing to contest this Notice. A request <br />for an - in writing and filed with the Executive Director <br />Cultural Set Department <br />receipt of this Notice at the following address: 100 W est I 01h Avenue, Suite 321, Eugene, OR 97401. <br />The Executive Director shall schedule a time and place for the informal hearing to be conducted, which shall be not <br />more than 72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Executive <br />Director will only consider testimony from yore., City personnel involved in the incident that resulted in this Notice, and <br />other witnesses to the incident. The Executive Director may exclude anyone, other than you and those presenting; <br />testimony, from the informal hearing. This Notice shall remain in effect pending any requested bearing. <br />This Notice of Restriction of Use was delivered to the person named at the fop of this Notice at the date and time shown <br />below by <br />A <br />(Signature of person issuing delivering notice) <br />K it <br />1 hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />