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LOCATION (PARKJOPEN SPACEY <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3 you are berebl <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />Igg jg ii� 1111 l�illilli 11 1 <br />MM � Will! <br />SO A W1 <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 infer al hearing to contest this Notice. A rQquest for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director la the Division Director") <br />within 48 hours (,exclusive of weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd_ Eugene, OR <br />97402. <br />72 In )urs (exclusive of'weekends) of receipt of the request for 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 testimony, from the informal hearing, <br />This Notice shall remain in effect pending any requested hearing. <br />TI Notice of Exclusion was delivered to the person named at the top of this Tslat the date and time shown above by <br />- .2-- — <br />of person i."Lling/deliVel'iDg n0tice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicaQNd-&kf%- <br />(Signature oFperson being issued tie notice) <br />W11 ite Copy: Pub I iC Works Green Copyy File Yellow Copyi Report Copy Pi 1) k Copy : kccipien r Gold Copy: Officer A ppea I notice Rev, 04.W <br />Naine,: Last F irst kliddle <br />DOB: <br />Racei e <br />, (71 <br />1 <br />> r2,k 'I Loy <br />Res. Addrc,-,s: City <br />State <br />Zip <br />Res. Phone: <br />Work 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 berebl <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />Igg jg ii� 1111 l�illilli 11 1 <br />MM � Will! <br />SO A W1 <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 infer al hearing to contest this Notice. A rQquest for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director la the Division Director") <br />within 48 hours (,exclusive of weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd_ Eugene, OR <br />97402. <br />72 In )urs (exclusive of'weekends) of receipt of the request for 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 testimony, from the informal hearing, <br />This Notice shall remain in effect pending any requested hearing. <br />TI Notice of Exclusion was delivered to the person named at the top of this Tslat the date and time shown above by <br />- .2-- — <br />of person i."Lling/deliVel'iDg n0tice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicaQNd-&kf%- <br />(Signature oFperson being issued tie notice) <br />W11 ite Copy: Pub I iC Works Green Copyy File Yellow Copyi Report Copy Pi 1) k Copy : kccipien r Gold Copy: Officer A ppea I notice Rev, 04.W <br />