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Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1,005( you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation-) <br />This restriction of use is effective beginning on- and shall remain in effect until <br />If Von enter in or use any City ofEugene park, open space or facility during the effe ctive period of this Notice, you may b e <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park an(] Open Space Rule R- 1.074 you are entitled to an informal hearing to contest this Notice, A request for all <br />infiormal hearing must be inade in writing and filed with the Parks & Open Space Division Director ("the Division detector'` <br />within 49 hours (exclusive of weekends) of receipt ol,"flus 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 inore than <br />72 hours (exchisive of weekends) of receipt ref f the request for hearing. At the informal hearing (he Division Director wffl Only <br />consider testimony frorn 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, frorn the informal hearing, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice ol'Exclusion was delivered to the person trained at the top of this Notice at the date and time shown above by <br />Nalnc: Last F'irst Middle <br />"A(Zb <br />DOB. <br />- <br />R wc/ sex - <br />o notice) <br />C4 <br />Res, Addr��.—Vp City <br />ess- <br />State <br />I 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( you are hereby <br />notified that you are prohibited from (check box). <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation-) <br />This restriction of use is effective beginning on- and shall remain in effect until <br />If Von enter in or use any City ofEugene park, open space or facility during the effe ctive period of this Notice, you may b e <br />arrested and charged with criminal trespass in the second degree. <br />Pursuant to Park an(] Open Space Rule R- 1.074 you are entitled to an informal hearing to contest this Notice, A request for all <br />infiormal hearing must be inade in writing and filed with the Parks & Open Space Division Director ("the Division detector'` <br />within 49 hours (exclusive of weekends) of receipt ol,"flus 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 inore than <br />72 hours (exchisive of weekends) of receipt ref f the request for hearing. At the informal hearing (he Division Director wffl Only <br />consider testimony frorn 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, frorn the informal hearing, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice ol'Exclusion was delivered to the person trained at the top of this Notice at the date and time shown above by <br />o notice) <br />I hereby acknowledge receipt of the above Notice on the date and fin indicated above. <br />(Signature of person being issued the notice) <br />While ( opy: Public Work� Grcen(opy: Felt Yellow Copy� Report Copy Pink Copy Recipient Gold Copy: Ufffixr Ape ,:M nc� ice Rc%, 04 /03 <br />