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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 />S� Entering in or using all City of Eugene parks, open spaces or facilities. <br />F1 <br />The basis for this Notice of Restriction of Use is that on r C you violated Section of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, yotr_ <br />oaxj d±Nawi!&�-T I- roerwt � <br />(Description of the violation.) <br />This restriction of use is effective beginning on r)9j( <br />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 />P ursuant to Park and Open Space Rule R - you are entitled to an informal hearing V,) contest this N otice , A request for an <br />informal 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 />72 hours t, exclusive of weekends) oFreceipt of the reouest for hearin . At the, iDthnnal hearin the Division Director will al <br />t <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />s <br />incident. The Division Director may exclude anyone, other than you and those presenting testi'mony, rrom the informal hearin <br />This Notice shall remain in effect pending any requested hearing. <br />(,Signature of person being issued the notice) <br />white copy: Public Work's Green Copy; File Yellow Copy: Report Copy Pink Copy; Recipien6 Gold Copy: Officer App(�al nntias Rev. 04/03 <br />Name; Lasl Fir5a Middle <br />b� <br />DOB: <br />Racy `Sex: <br />a. <br />oqA) <br />aL&6 <br />Res, Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />f <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 />S� Entering in or using all City of Eugene parks, open spaces or facilities. <br />F1 <br />The basis for this Notice of Restriction of Use is that on r C you violated Section of the Park <br />and Open Space Rules, and/or Section of the Eugene Code, 1971, and/or ORS To wit, yotr_ <br />oaxj d±Nawi!&�-T I- roerwt � <br />(Description of the violation.) <br />This restriction of use is effective beginning on r)9j( <br />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 />P ursuant to Park and Open Space Rule R - you are entitled to an informal hearing V,) contest this N otice , A request for an <br />informal 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 />72 hours t, exclusive of weekends) oFreceipt of the reouest for hearin . At the, iDthnnal hearin the Division Director will al <br />t <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses to t <br />s <br />incident. The Division Director may exclude anyone, other than you and those presenting testi'mony, rrom the informal hearin <br />This Notice shall remain in effect pending any requested hearing. <br />(,Signature of person being issued the notice) <br />white copy: Public Work's Green Copy; File Yellow Copy: Report Copy Pink Copy; Recipien6 Gold Copy: Officer App(�al nntias Rev. 04/03 <br />