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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 />riotified that you are prohibited from (check box): <br />1W Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on _Q�o �VA you violated, Section the Park <br />and Open Space Rules, and/or Section qJITL of the Eugene Code, 1971, and/or ORS <br />(Description of the violation.) <br />. To wit, you: <br />This restriction of use is effective beginning on and shall remain in effect until o <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 />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 of this Notice at the following address 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the infort 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 at the date and time shown above by: <br />_(S1_92�nil_ture of person ,4. , /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Whim Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy Officer Appe.&I notice Rev. W0.1 <br />Name: Last First Middle <br />DOB: <br />Racc/SeX: <br />N <br />Res. Address: City <br />state <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 />riotified that you are prohibited from (check box): <br />1W Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />The basis for this Notice of Restriction of Use is that on _Q�o �VA you violated, Section the Park <br />and Open Space Rules, and/or Section qJITL of the Eugene Code, 1971, and/or ORS <br />(Description of the violation.) <br />. To wit, you: <br />This restriction of use is effective beginning on and shall remain in effect until o <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 />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 of this Notice at the following address 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the infort 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 at the date and time shown above by: <br />_(S1_92�nil_ture of person ,4. , /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Whim Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy Officer Appe.&I notice Rev. W0.1 <br />