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-ry 0 s U <br />notified that you are prohibited from (check box): <br />I,— <br />0/ Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation,) <br />This restriction of use is effective beginning on and shall remain in effect until <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 />infortnal 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 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 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 />(Signature of persc)jiss 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 />While Copv: Public Works Chen Copy: File Yellow Copy: Repo&. Copy Pink Copy, Rccipiens Gold Copy: Offiwer Appeal notice Rev. 04'03 <br />Name. L st F111 Middle <br />L L ff� 5 - - I t <br />DOB: <br />c t 9;5 <br />Race/Sex <br />N� <br />Pz:A <br />� <br />Res. Address: City <br />State <br />Zip <br />Reg. Phone: <br />Work Phoney <br />-ry 0 s U <br />notified that you are prohibited from (check box): <br />I,— <br />0/ Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation,) <br />This restriction of use is effective beginning on and shall remain in effect until <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 />infortnal 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 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 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 />(Signature of persc)jiss 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 />While Copv: Public Works Chen Copy: File Yellow Copy: Repo&. Copy Pink Copy, Rccipiens Gold Copy: Offiwer Appeal notice Rev. 04'03 <br />