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and Notice of Right to Appeal <br />5\ <br />DAT�! —&fo—vy-- TIME: )A-O CASE <br />LOCATION (PARK/OPEN 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 hereby <br />wifiried that you are prohibited from (check box): <br />V — Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />M 4 <br />ipffion of the violation.) <br />This restriction of use is effective beginning 7 <br />on g and shall remain in effect until <br />10 <br />I f` 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 arc entitled to an info al hearing to contest this Notice, A request for an <br />info al 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 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 infix gal 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 Non cc of Exclusion was delivered to the person named at the top of this NotiSo-S the date and tinre shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the data and time in <br />--- Az� - -- - ---------- <br />(Signature of person being issued the notice) <br />White Copy: Public Work,; Green Copy Fite Yellow Cepy Report Copy Pink Copy, Recipient Gold Ccipy Officer Appeal mAicc� Rc�, 044(13 <br />Name: 1-ast First Middle <br />DO <br />e" <br />e <br />Res. Address: y t <br />It <br />State <br />ZIP <br />Res, Phone: <br />Work hone! <br />71 <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 />wifiried that you are prohibited from (check box): <br />V — Entering in or using all City of Eugene parks, open spaces or facilities. <br />0 <br />M 4 <br />ipffion of the violation.) <br />This restriction of use is effective beginning 7 <br />on g and shall remain in effect until <br />10 <br />I f` 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 arc entitled to an info al hearing to contest this Notice, A request for an <br />info al 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 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 infix gal 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 Non cc of Exclusion was delivered to the person named at the top of this NotiSo-S the date and tinre shown above by: <br />of person issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the data and time in <br />--- Az� - -- - ---------- <br />(Signature of person being issued the notice) <br />White Copy: Public Work,; Green Copy Fite Yellow Cepy Report Copy Pink Copy, Recipient Gold Ccipy Officer Appeal mAicc� Rc�, 044(13 <br />