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Under the authority of Administrative Qrder. No. 58- 03 -24-F and Psut sl<nd t>s liae R 4 X005(3), your he>tyelay Entering in or using an City of Eugene parks, open spaces or facilities. The basis for this Notice of Restriction of Use is that on / , you violated Section ' of the Park <, and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: (Description of the violation.) This restriction of use is effective beginning on . ' and shall remain in effect until �If,.you enter in or use any City of Eugene park, open space or facility during the effective period of this Neese; you may be arrested and charged with criminal trespass in the second degree. 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 informal hearing must be made in writing and filed with the Parks & Open Space Division Director ( "the Division Director") within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR 97402. The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than 72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only consider testimony from you, City personnel involved in :the incident that resulted in this Notice, and other witnesses to the incident. The Division Director may exclude anyone, other than you and those presenting testimony, fr the informal hearing. This Notice shall remain in effect pending any requested hearing, This Notice of F-x61UgkWW*s- to the person, namodat the top of this Notice at the date and time shown above by: (Signature 5Ke rson issuing/del notice)' I hereby acknowledge receipt of the above Notice on the date and time indicated above. (Signature of person being issueXthe notice) White Copy: Public Works. Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03 ame: bast First 1Gtiddle DOB: Race /Sex: U Res— '. C' State Zip `lies. Phone: Work Phone: Under the authority of Administrative Qrder. No. 58- 03 -24-F and Psut sl<nd t>s liae R 4 X005(3), your he>tyelay Entering in or using an City of Eugene parks, open spaces or facilities. The basis for this Notice of Restriction of Use is that on / , you violated Section ' of the Park <, and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, you: (Description of the violation.) This restriction of use is effective beginning on . ' and shall remain in effect until �If,.you enter in or use any City of Eugene park, open space or facility during the effective period of this Neese; you may be arrested and charged with criminal trespass in the second degree. 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 informal hearing must be made in writing and filed with the Parks & Open Space Division Director ( "the Division Director") within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR 97402. The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than 72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only consider testimony from you, City personnel involved in :the incident that resulted in this Notice, and other witnesses to the incident. The Division Director may exclude anyone, other than you and those presenting testimony, fr the informal hearing. This Notice shall remain in effect pending any requested hearing, This Notice of F-x61UgkWW*s- to the person, namodat the top of this Notice at the date and time shown above by: (Signature 5Ke rson issuing/del notice)' I hereby acknowledge receipt of the above Notice on the date and time indicated above. (Signature of person being issueXthe notice) White Copy: Public Works. Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Rev. 04/03