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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 />3W Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice ol'Restriction of Use is that on you violated Section /�_O 10 jVof the Park <br />and Open Space Rules, and/or Section Of the Eugene Code, 1771, and/or ORS To wit, you: k.4 Qja <br />(,Description of the violation.) <br />This restriction of use is effective beginnin 'M / / q and shall remain, in effec u g on t un <br />If you enter in OF USC any City of ugene park, open space or facility during the effective period of this Notice, yen may be <br />arrested and charged with criminal trespass in the second degree. <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 for hearing. At the informal hearing the Division Director will on]y <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 time shown above by: <br />9�1-�er - --------- (Signatureof person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />\1 1) <br />(Signature of hereon being issued the notice,) <br />Whi ('(TT Publiv Works Green0jpy: rile YeAlow c,,Py: R�Pori Copy Pink Cojiy: Recipient Cold Copy: Officer Appal io6ce Rev, (W03 <br />Name Last First Middle <br />DOB: <br />7) <br />Res- Addres�: city <br />State <br />Zip <br />Work ' hone: <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 />3W Entering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />The basis for this Notice ol'Restriction of Use is that on you violated Section /�_O 10 jVof the Park <br />and Open Space Rules, and/or Section Of the Eugene Code, 1771, and/or ORS To wit, you: k.4 Qja <br />(,Description of the violation.) <br />This restriction of use is effective beginnin 'M / / q and shall remain, in effec u g on t un <br />If you enter in OF USC any City of ugene park, open space or facility during the effective period of this Notice, yen may be <br />arrested and charged with criminal trespass in the second degree. <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 for hearing. At the informal hearing the Division Director will on]y <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 time shown above by: <br />9�1-�er - --------- (Signatureof person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />\1 1) <br />(Signature of hereon being issued the notice,) <br />Whi ('(TT Publiv Works Green0jpy: rile YeAlow c,,Py: R�Pori Copy Pink Cojiy: Recipient Cold Copy: Officer Appal io6ce Rev, (W03 <br />