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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 />notified that you are prohibited from (check box): <br />X Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on you violated Section f the Park, <br />Al <br />and Open Space Rules, and/or Section 9 P of the Eugene Code, 1971, and/or ORS --. To wit., you:_ <br />(Description of the violation,) <br />This restriction of use is effective beginning on and shall remain in effect until <br />I fyou enter in or use any City of Eugene park open space or facility during the effective period o 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- you are entitled to an infortrial hearing to contest this Notice. A request fear all <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 wcckends) 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 11OLirs (exclusive ot'weekends) of receipt of the request for hearing. At the informal hearing the Di-vision 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 tnay 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 nanied at the top (if this Notice at the date and time shown above by: <br />(Signature orperson isSL!ing/defivering 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 Copy Public Works Green Copy_ Fde Yellow Ccspy: Report Copy Pink ropy; Ronpient Gold Copy OfIrwer Appeal nc)fice Re 04tM <br />Name' Last first Middle <br />DOB <br />CUP 1 <br />Res. Address: City <br />State <br />Zip <br />Res. Phone <br />Work Phone.'. <br />rijc_ 11r, )�I' w <br />e4 2 <br />-,T)(50 <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 box): <br />X Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />The basis for this Notice of Restriction of Use is that on you violated Section f the Park, <br />Al <br />and Open Space Rules, and/or Section 9 P of the Eugene Code, 1971, and/or ORS --. To wit., you:_ <br />(Description of the violation,) <br />This restriction of use is effective beginning on and shall remain in effect until <br />I fyou enter in or use any City of Eugene park open space or facility during the effective period o 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- you are entitled to an infortrial hearing to contest this Notice. A request fear all <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 wcckends) 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 11OLirs (exclusive ot'weekends) of receipt of the request for hearing. At the informal hearing the Di-vision 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 tnay 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 nanied at the top (if this Notice at the date and time shown above by: <br />(Signature orperson isSL!ing/defivering 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 Copy Public Works Green Copy_ Fde Yellow Ccspy: Report Copy Pink ropy; Ronpient Gold Copy OfIrwer Appeal nc)fice Re 04tM <br />