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L <br />Name� Last I - I'st <br />Race/S -N <br />7k <br />LQ <br />l <br />..... .... . <br />Res, Addre. C ity <br />C <br />State <br />Zip <br />Res. f <br />Work Phone: <br />U nder the authority of : dmin strative Order No. 58-03-24- F and Park and Open Space Rule R- 1.005(.3), yearn are hereby <br />notified that you are prohibited from (check box)-. <br />)K in or using all City of Eugene parks, open spaces or facilities. <br />W <br />The basis for this Notice of Restriction of Use is that on 0 0 <br />Yos , you violated Section b 0 of the Park <br />- �f <br />and Open Space Rules, and/or Section of the Eugene ("ode, 1971, and/or ORS To wit, you <br />00,6- )yJ -4�-�-JA&< Af ffbby <br />Pursuant to Park and Open Space Flute R- 1. 0 74 you are entitled to an informal hearing to contest this Notice. 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 receipt ofthis Notice at the following address: 1820 RGosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />73 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 />incidenL 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 marred at the top of this Notice at the date and time shown above by <br />(Signature of person is-suing./defivering nollce <br />I hereby acknowledge receipt ofthe above Notice on the date and firric indicated above. <br />(Signature of'person being issued the notice) <br />`Vltile Copy: Pubin" Works Green Copy: File Yellow Copy Repo ft Copy Pink Copy: Recipient Gold Cople Officer Appval notwc Rm 041CR <br />