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goNOTICE OF RESTRICTION OFUSE <br />3"d Notice of'Right to Appeal <br />DATE: <br />TIME: CASE if <br />I OCATION (PARK/OPFN SPACE): W EST` <br />Narnc. Last <br />T <br />Res. is Lis: <br />AkS— <br />�X <br />M <br />Middic D013: R <br />"'state <br />State 4 Res "lne' Wort Phcpuje <br />0� <br />'-�;-'743to,347 ' '' <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 />notified that you are prohibited from (check hox) <br />119-1 Entering in or using all City of Eugene parks, open spaces or facilities. <br />01 <br />The hasis lbr this Notice of Restriction of Use is that on <br />and Open Space Rules, and/or Section L ofthe F"u <br />you violated Section r. �c) I the Rark <br />e Code, 197 1 . and/or 0 RSI&.q <br />To wit, yow <br />A <br />(Description of the violation,) <br />This restriction of use is effective beginning on7 and shall remain in effect until <br />. . .............. . . ......... . . .... zk <br />Ifyou enter in or use any City ofEugerne park, open space or fficility during the effective period of this Notice, you in ay be <br />arrested and. charged with criminal trespass in the second degree. <br />Pursuant to Park and Open Space Rule R-4.074 your tare entitled to an informal hearing to contest this Notice. Arcquie'stknan <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division 13irector") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the ffiflowing address: 1820 Roosevelt, 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 />72 hours (exclusive of weekends) of receipt of the request for hearing, At the inforinal hearing the Division Director will only <br />corlsider testimony from yon, City personnel involved in the incident that resulted in this Notice, and other witinesses tio 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 t the date aw 11ne shwim above lby�: <br />. . . . . . . . . ----- . ........................................ . . . . .. <br />(Signatur, (Aperson issuing/delivering noticv,,) <br />—rP Is() <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature ofperson being issued the notice) <br />Wh4e Copy: Pubk Works Gmm Copy; Fjiv Yc[k)m Copy; Rcpori ("copy Pink Ciipp: Rcvipivn� Gv[d ('opy; Offhx.r Appval rl'Awe <br />Rev. 04,103 <br />White, Copy; Public WC'4(been (:'upy: File YeHow Copy: Repcmi Cop, Pink (.'ojpyIRecipient Gold 4upy: (VEccr App „ail ncPticc, R,rv- 10';IVO� <br />