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4 <br />Nwne: Last First Middle <br />DO 3: <br />R ce,`Sex <br />a - <br />A <br />U <br />Res. Address: City <br />Slate J!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(3), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using a <br />ill City of Eugene parks, open spaces or facilities. <br />X I <br />V <br />The basis for this Notice of Restriction of Use is that ore , 1� <br />--? !- � , you violated Section J-1-0-4 if the Park. <br />and Open Space Rule%, and/or Section ? of the Eugene Code, 1971, and/or ORS "7 To wit, you n. <br />IV � <br />(Dewription of the violation.) <br />This restriction or use is effective beginning on 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 an informal hearing to contest this Notice. A request for art <br />infornial hearing must be made in writing and filed with the parks & Open Space Division Director ("the Division Director <br />within 48 hours, (exclusive of weekend-,) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402, <br />The Division Director shall schedule a tutee 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 for hearing, At the inibri 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 nwned at the top of this Notice at the date and time shown above by: <br />At 44zeg�lvr- <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledgc receipt of the above Notice on the dale and time indicated above. <br />i <br />nature of person being issued the non ce) <br />White Copy: Public Works GreenCcppy: File YcHo"N' "'.spy" Repo v. Copy Pink Copy: Recipient 6 old Copv: C) ffi rer A 1) peal notice Re 0-11'01 <br />