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M <br />DATE: 6 3.2-D / 3 <br />and Notice of Right to Appeal <br />TIME: <br />6 <br />V1 <br />0�2-91 <br />CASE #: <br />( /<' <br />z <br />Name: Last <br />First Middle <br />DOB: <br />Race /Se.: <br />11 dm -5 <br />6) 0 <br />Res. Addres <br />city <br />state <br />ZIP <br />Res. Phone: <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are hereby <br />- 96- Entering in or using all City of Eugene parks, open spaces or facilities. <br />87 <br />The basis for this Notice of Restriction of Use is that on 01 2 d it - 3 you violated Section of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS -. To wit, you:_ <br />This restriction of use is effective beginning on 0 3:2-0 1-3 , and shall remain in effect until 0 i6a 20 / 3 <br />If you enter in or use any City of Eugene park, open space or facility during the effective period of this Notice, you may be <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, A request for an <br />97402. <br />- MW <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />'s <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the infor:rnal 7hearin <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 at the ate and time shown above by: <br />issuing/delivering notice) <br />