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z <br />Name: Last First Middle <br />i <br />DOB <br />0 17 <br />Oil- <br />Ra <br />Ij <br />Res, Address. t=its= <br />St �Ie <br />Zip <br />Res. Phone: <br />Work P <br />Under the authority of Admiuistrative 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 />-7/- Entering in or using all City of Eugene parks, open spaces or facilities. <br />H <br />The basis for this Notice of Restriction of Use is that on is 0 q - I , you violated Section - of the Park <br />and Open Space Rules, and/or Section L l m of the Eugene Code, 197 1, and/or ORS - 1 11 ---l- To wit, you:___ <br />(Description of the violation. l <br />This restriction of ime is effective beginning on and shall remain in effect tin til 10 <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. Arequestforan <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 4S kann <br />- uFF - Me fcquesl lLn t'Li uITTIM171171 11171Mig NIT urv <br />fluui S kc;,k:rusyve wccixllu�5 ; ul lcuclpt H - . <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 EXHUqion was delivered to the person named at the top of this Notice at t at d hown above by! <br />(SignatUre ol'person iswuing/delivcring nolice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of person being issued the notice) <br />Whue Cory Public Works Green Copy! File Yelhw cory! Relic, n C opy Pink Copy: Rc�6poent G Ai C, rpy: O fficer A ppeal no ice Re 04"01 <br />M <br />