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Under the authority of, d. inistrative 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 />Fntering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on —44114-1-- you violated Section J.-PLC o the Park <br />and Open Space Rules, and/or Section 'A � ) � /3 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 <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 all <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the. Division Director") <br />within 4 8 hours (exel usi ve of weekends) of receipt of this Notice at the f6flowin g address: 1820 Roosevelt, Blvd., E ugene, O lt <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 week ofreccipt of the request fear hearing. At the informal 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 testiniony, from the info rTna I heurng. <br />This Notice shall remain in of 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 />(Signature of person issuing delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and firne indicated above, <br />C <br />(Signature ofperson being issued the notice) <br />Wh i Ic Cup Y! P A I i c Work v Gman Cupy: File Y H ow Copy: kcpor! C opy Pink Copy: Rmpient Uold Copy� Officer Appea I natice Rm (4"03 <br />Name: Last First Middit <br />DOB� <br />R ace .-ISex: <br />f P-f -0taZINN C- -X� <br />la/f <br />Res. ANEeW. City <br />State <br />Zip <br />T <br />Re Phone: <br />Work Phone: <br />j <br />Under the authority of, d. inistrative 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 />Fntering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on —44114-1-- you violated Section J.-PLC o the Park <br />and Open Space Rules, and/or Section 'A � ) � /3 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 <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 all <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the. Division Director") <br />within 4 8 hours (exel usi ve of weekends) of receipt of this Notice at the f6flowin g address: 1820 Roosevelt, Blvd., E ugene, O lt <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 week ofreccipt of the request fear hearing. At the informal 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 testiniony, from the info rTna I heurng. <br />This Notice shall remain in of 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 />(Signature of person issuing delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and firne indicated above, <br />C <br />(Signature ofperson being issued the notice) <br />Wh i Ic Cup Y! P A I i c Work v Gman Cupy: File Y H ow Copy: kcpor! C opy Pink Copy: Rmpient Uold Copy� Officer Appea I natice Rm (4"03 <br />