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LOCATION (PARKJOPEN SPACE): <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are herelav <br />notified that you are prohibited from (check box): <br />X Entering in or using all City of Eugene parks, open spaces or facilitil <br />X <br />(Description of the violation.) <br />This restriction of use is effective beginning on&' <br />� , and shall remain in effect until <br />If you enter in or use any C ity of Eugene park, open space or facility d uring the effective period of thi s police, 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 an <br />infortnal hearing must 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., Eugene, OR <br />97402. <br />The Division Director shall SChUdLdC a tilne. and place fifer 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 informal hearing the Division Director will only <br />consider testimony froin 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 ol'ExckiqiOrk was delivered to the person named at the top ofthi.q Notice at the data and time shown above by <br />7g—jjJure of siu is <br />'U,l <br />(�ignature of I' s,;on issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date, aid th indicated above. <br />(Signature of_perqon being issued the notice) <br />White' Copy- PuhlriWorks Green Copy! File Yellow Copy: Report Copy Pink Copy! Rtecipient Gold Copy: Officer Appeal nouee Rev- 041TO <br />Nanie Last st Middle <br />DOB� <br />Race/S <br />re <br />3 467 <br />41 <br />Res. Address: city <br />Stake <br />Zip <br />Res- Phone: <br />Work Phoney <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are herelav <br />notified that you are prohibited from (check box): <br />X Entering in or using all City of Eugene parks, open spaces or facilitil <br />X <br />(Description of the violation.) <br />This restriction of use is effective beginning on&' <br />� , and shall remain in effect until <br />If you enter in or use any C ity of Eugene park, open space or facility d uring the effective period of thi s police, 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 an <br />infortnal hearing must 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., Eugene, OR <br />97402. <br />The Division Director shall SChUdLdC a tilne. and place fifer 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 informal hearing the Division Director will only <br />consider testimony froin 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 ol'ExckiqiOrk was delivered to the person named at the top ofthi.q Notice at the data and time shown above by <br />7g—jjJure of siu is <br />'U,l <br />(�ignature of I' s,;on issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date, aid th indicated above. <br />(Signature of_perqon being issued the notice) <br />White' Copy- PuhlriWorks Green Copy! File Yellow Copy: Report Copy Pink Copy! Rtecipient Gold Copy: Officer Appeal nouee Rev- 041TO <br />