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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 />X Entering in or using all City of Eugene parks, open spaces or faciliti". <br />X <br />Pursuant to Park and Open Space Rule R yoti are entitled to an informal hearing to contest this Notice A request for an <br />informal hearing must be Tnade in writing and fi led with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends ofrecelpt (if this Notice at the following address: 1820 Roosevelt', Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule as firne and place for the hil"ormal hearing to be conducted, which shall be not 111ore thall <br />72 hours (exclusive of%veekends) of receipt of the request for hearing. At the infi hearing the Division Director will only <br />consider testimony f•Olu YOLL, CitV personnel involved in the incident that resulted in this Nonce, and other wituesses 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 ot'Exclusion was delivered to the person named at the top of this Notice at the date and time shown above byi <br />(Signature cif person issuirigi'delivering notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated abovc <br />(; Signature of person being iSSUed the tlOfiCCI <br />While ( L)pv! Public Works Ueen('upy Filc Ycfl ow Copy: kq)on Copy Pink `op Recipimt Odd Copy: 0 Mimi- Appc�fl llo[ix Rev 0 4146 <br />Name Last First Middle <br />DOB: <br />( �q <br />Res. Addre.�,& City State Zip <br />Rc� phone; <br />Wotk 1 <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 />X Entering in or using all City of Eugene parks, open spaces or faciliti". <br />X <br />Pursuant to Park and Open Space Rule R yoti are entitled to an informal hearing to contest this Notice A request for an <br />informal hearing must be Tnade in writing and fi led with the Parks & Open Space Division Director ("the Division Director") <br />within 48 hours (exclusive of weekends ofrecelpt (if this Notice at the following address: 1820 Roosevelt', Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule as firne and place for the hil"ormal hearing to be conducted, which shall be not 111ore thall <br />72 hours (exclusive of%veekends) of receipt of the request for hearing. At the infi hearing the Division Director will only <br />consider testimony f•Olu YOLL, CitV personnel involved in the incident that resulted in this Nonce, and other wituesses 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 ot'Exclusion was delivered to the person named at the top of this Notice at the date and time shown above byi <br />(Signature cif person issuirigi'delivering notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated abovc <br />(; Signature of person being iSSUed the tlOfiCCI <br />While ( L)pv! Public Works Ueen('upy Filc Ycfl ow Copy: kq)on Copy Pink `op Recipimt Odd Copy: 0 Mimi- Appc�fl llo[ix Rev 0 4146 <br />