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LOCATION (PARK/OPEN SPACE):___pASc4ii! r PAR-V, <br />U uder th e authority o F Administrative Order N a. 58-03-24-F a nd Park a nd Open Space Rule R- 1 M5(3 yo u a re hereby <br />notified that you are prohibited from (check box): <br />Entering io or using all City of Eugene parks, open spaces or faciliti <br />V <br />(Description o the violation.) <br />This restriction of use is effective beginning on M '21 2,:xLf , and shall remain in effect until M 71 2614 - <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 - .074 you are entitled to an informal hearing to contest this Notiec 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 (if weekends) of receipt ofthis Notice at the rollowing 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 hours (exclusive ofweekends) 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 witriesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, frorn the informal hearing. <br />This Notice shall remain in erfect 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 />,72) <br />pers j, <br />(Signature o person o uing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person being issue?Ytn�o <br />W h �tc Copy: Pub] ic 'A'urk Green Cvpy: File Yellow Copy, Repon Copy Pink Cnpy� Recipient Oold Copy, Appeal n0dQ,0 - 04A) 3 <br />Nanie: Last <br />First Middle <br />DOB: <br />Racc, <br />0S 199q <br />Fr <br />Res. Address: <br />City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />n� <br />U uder th e authority o F Administrative Order N a. 58-03-24-F a nd Park a nd Open Space Rule R- 1 M5(3 yo u a re hereby <br />notified that you are prohibited from (check box): <br />Entering io or using all City of Eugene parks, open spaces or faciliti <br />V <br />(Description o the violation.) <br />This restriction of use is effective beginning on M '21 2,:xLf , and shall remain in effect until M 71 2614 - <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 - .074 you are entitled to an informal hearing to contest this Notiec 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 (if weekends) of receipt ofthis Notice at the rollowing 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 hours (exclusive ofweekends) 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 witriesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, frorn the informal hearing. <br />This Notice shall remain in erfect 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 />,72) <br />pers j, <br />(Signature o person o uing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(Signature of person being issue?Ytn�o <br />W h �tc Copy: Pub] ic 'A'urk Green Cvpy: File Yellow Copy, Repon Copy Pink Cnpy� Recipient Oold Copy, Appeal n0dQ,0 - 04A) 3 <br />