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and Notice of Right to Appeal <br />DATE: 3 �),l 13 TIME: J CASE #: <br />LOCATION (PAR_K/OPEN SPACE)}� <br />z <br />Naine F Middle <br />DOB <br />Race/ sex: <br />am �5ppf, A 6�111 <br />129-229V <br />Res. Address: City <br />State <br />Zip <br />lei;q . <br />R es, Phone: <br />Phone <br />Mh W <br />JC/ <br />Under the authori . of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(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 />FA <br />The basis for this Notice of Restriction of Use is that on you violated Section of the Park <br />Open Space Rules,and/or Section <br />(Description of the violation.) <br />To wit, you:_ <br />This restriction of use is effective beginning on _Q� �3, and shall remain in effect until 6 1 2U_ <br />0 �94 <br />Pursuant to Park and Open Space Rule R- 1.074 you are entitled to an informal hearing to contest this Nofice A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends) of receint of this Notice at the followinp address: 1820 Roosevelt, Blvd., Eugeut,-OR <br />97402. <br />The Division Director shall schedule a time and place for the infon hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal 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 Notice the date and time shown above by- <br />W3 <br />(Signa c of person issuing/delivering notice) <br />