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LOCATION (PARKJOPEN SPACE): <br />p k- <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 />Entering in or using all City of Eugene parks, open spaces or facilities. <br />W. <br />This restriction of use is effective beginning on shall remain in effect until <br />If you enter in Or USe any City of Eugene park, open space or facility during the e [Tective 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 49 hours (exclusive cif eel of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eu;vne, OR <br />97402. <br />­7 11 <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident, The Di vision Director may exe lude anyone, other than you and those presenting testimony, from the informa I hearing. <br />T his Notice shall remain in effect pending any requested hearing. <br />This Notice of Exchisi on was del ivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of peison being issued the notice) <br />Wlifte Copy: Public, Wuiks Gn-en Copyz Mir Yellow Ccpy Report Copy Pink Copy: Recipient Go Copy 0 ffic er A ppea I notice Re 04,03 <br />Narne. Last First Middle <br />DOB� <br />Race,/Sex: <br />L rt C <br />to <br />R d City <br />State <br />;dip <br />Z <br />Phones <br />Res. Pho <br />Work Phone: <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 />Entering in or using all City of Eugene parks, open spaces or facilities. <br />W. <br />This restriction of use is effective beginning on shall remain in effect until <br />If you enter in Or USe any City of Eugene park, open space or facility during the e [Tective 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 49 hours (exclusive cif eel of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eu;vne, OR <br />97402. <br />­7 11 <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident, The Di vision Director may exe lude anyone, other than you and those presenting testimony, from the informa I hearing. <br />T his Notice shall remain in effect pending any requested hearing. <br />This Notice of Exchisi on was del ivered to the person named at the top of this Notice at the date and time shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of peison being issued the notice) <br />Wlifte Copy: Public, Wuiks Gn-en Copyz Mir Yellow Ccpy Report Copy Pink Copy: Recipient Go Copy 0 ffic er A ppea I notice Re 04,03 <br />