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Under the authority ofAdministrative 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 />(Description of the violation.) <br />This restriction of use is effective beginning on oc 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 art 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 of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director sha schedule a time and place for the in formal hearing to be conducted, which sha 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 />----------- <br />(Signature of person issui Lig/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />— ------ - - - - - <br />(Signature of person being issued the notice) <br />white Copy: Public Work" Green Cope! Fih Yd1ow Cupv: Report Copy Pink Cvpy kccipim (Ad Cbpy Offic rr Appail noT, i c c Rey, 04,46 <br />Nai ast First Middle <br />0'\4 <br />DOB <br />C <br />Race <br />(\Aj,�,3 <br />Rts, AddTess: City <br />I State <br />I ZiD <br />ReSL MR)TIe: <br />Work Phone <br />Under the authority ofAdministrative 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 />(Description of the violation.) <br />This restriction of use is effective beginning on oc 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 art 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 of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director sha schedule a time and place for the in formal hearing to be conducted, which sha 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 />----------- <br />(Signature of person issui Lig/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />— ------ - - - - - <br />(Signature of person being issued the notice) <br />white Copy: Public Work" Green Cope! Fih Yd1ow Cupv: Report Copy Pink Cvpy kccipim (Ad Cbpy Offic rr Appail noT, i c c Rey, 04,46 <br />