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Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open splices or facilities. <br />The basis for this Notice of Restriction of Use is that on you violated Section I f e Park <br />and Open Space Rules, and/or Section -- of the Eugene Code, 1971, and/or ORS To wit, you:_ <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until (3'1 -p k1A <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- 1.0374 you are entitled to an infornial hearing to contest this Notice, A request for an <br />info al hearing niust 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., Eug 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 of weekends) of receipt of the request ror hearing. At the inimmal 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 tinre shown above by <br />(Signature of person issin notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />- ------ — -------------------------- <br />(Signature of person being issued the notice) <br />`Nlnte Copy: PuHie Workw Greo copy File Y6 ow Copy. krport Copy Pink Copy: Recpen (kild Cory (WrLcer App�ai 1106" mc%, 041t3 <br />Name. Lest First Middle <br />D013: <br />Racc/Sex: <br />}} <br />U <br />Res. Address: City <br />Stag <br />ZIP <br />Res. Phone: <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005( you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open splices or facilities. <br />The basis for this Notice of Restriction of Use is that on you violated Section I f e Park <br />and Open Space Rules, and/or Section -- of the Eugene Code, 1971, and/or ORS To wit, you:_ <br />(Description of the violation.) <br />This restriction of use is effective beginning on and shall remain in effect until (3'1 -p k1A <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- 1.0374 you are entitled to an infornial hearing to contest this Notice, A request for an <br />info al hearing niust 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., Eug 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 of weekends) of receipt of the request ror hearing. At the inimmal 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 tinre shown above by <br />(Signature of person issin notice) <br />I hereby acknowledge receipt of the above Notice on the date and tirne indicated above. <br />- ------ — -------------------------- <br />(Signature of person being issued the notice) <br />`Nlnte Copy: PuHie Workw Greo copy File Y6 ow Copy. krport Copy Pink Copy: Recpen (kild Cory (WrLcer App�ai 1106" mc%, 041t3 <br />