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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 />nolified drat you are prohibited from (check box), <br />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 info al 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 info real hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ofreceipt of the request for hearing. At the informal hearing the Division Dircctorwi 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 to of this Notice at the date and time shown above by: <br />q <br />(Signature of 1 son issuing/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 />Whkk Copy: PuMQ 'Xorkg Green CUPY: Fite Yellow Copy; Rvporl Copy Pink Cbpy� Rmpm Gold Copy. Of Appeal aiuuce Rev, 1AVCH <br />Natnc: Last r First Middle <br />U <br />DOB <br />77- <br />Cli <br />Reg. AddreLss:, Ci1v <br />1 <br />S tate <br />IS h <br />Zi; <br />050� <br />p� Ohnno <br />R p _' I - <br />LAI <br />�)r k Phone: <br />-�T� <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 />nolified drat you are prohibited from (check box), <br />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 info al 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 info real hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) ofreceipt of the request for hearing. At the informal hearing the Division Dircctorwi 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 to of this Notice at the date and time shown above by: <br />q <br />(Signature of 1 son issuing/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 />Whkk Copy: PuMQ 'Xorkg Green CUPY: Fite Yellow Copy; Rvporl Copy Pink Cbpy� Rmpm Gold Copy. Of Appeal aiuuce Rev, 1AVCH <br />