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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 />qotified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facillitiel <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 />The Division Director shall schedule a time and place for the infornial hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request lor hearing, At the informal hearing the Division Director will only <br />consider testimony from you, City personnel it 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 fink shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated above. <br />U - 140 <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy! Fite Yellow Copy: Rc-port Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Re%, 04/03 <br />Name: Last # First Middle <br />DOB <br />Race, 'Sex: <br />ILI <br />Res. Addreqs-. u Y. city <br />1- 0" l b s T— <br />state <br />Zip <br />Res. Phone: <br />Wort Phone: <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 />qotified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facillitiel <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 />The Division Director shall schedule a time and place for the infornial hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request lor hearing, At the informal hearing the Division Director will only <br />consider testimony from you, City personnel it 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 fink shown above by: <br />(Signature of person issuing/delivering notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated above. <br />U - 140 <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy! Fite Yellow Copy: Rc-port Copy Pink Copy: Recipient Gold Copy: Officer Appeal notice Re%, 04/03 <br />