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NOTICE OF REs OF USE N � (�A X51 <br />and Notice of Right to Appeal <br />L0(-'.ATl0N (PARK"UPEN SPACE)r . .................... <br />Under the authority of Ndministrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are era icy <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />(Description of the violation,) <br />This restriction of use is effective beginn ing on tfa nd shall rem airy in effect until y <br />If YOU enter in or use any City of Flugene 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, )74 you are entitled to an informal hearing to contest this Notice. A request for an <br />nif'ornial hearing must be made in writing and Filed with the Parks & Open Space Division Director ("the 1-')Ivislon Director") <br />within 48 hOUFS (exclusive of weekends) of receipt of this Notice at the fiollowing address: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedule a tfirte and place fbr the informal hearing to be conducted, which shall be not more than <br />72 hours iexclusine of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses W the <br />inc The Division Direct or may exclude anyone, other than you and those presenting testa - nony, frorn the in forinal I kearing. <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 time shown above by: <br />(Signamre ofperson Issuing/delivering notice) <br />I hereby acknowledge receipt ofthe above Not on [lie date and time indicated above, <br />(Signature 0/rsollhel g, issued the notice) <br />White Pkjhli(: Work (aecil Copy: File Y allow Copy: Kqlorl, C opy N A t op Res ipieju Gold Copy: Offlicu Apps it nolwe Rev. 04,103 <br />Middle <br />DOB: <br />R a c <br />Cart <br />i Zip <br />Res, Phone <br />�A'ork 1 <br />"IF aL 94g;q5 <br />Under the authority of Ndministrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are era icy <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />X <br />(Description of the violation,) <br />This restriction of use is effective beginn ing on tfa nd shall rem airy in effect until y <br />If YOU enter in or use any City of Flugene 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, )74 you are entitled to an informal hearing to contest this Notice. A request for an <br />nif'ornial hearing must be made in writing and Filed with the Parks & Open Space Division Director ("the 1-')Ivislon Director") <br />within 48 hOUFS (exclusive of weekends) of receipt of this Notice at the fiollowing address: 1820 Roosevelt, Blvd, Eugene, OR <br />97402. <br />The Division Director shall schedule a tfirte and place fbr the informal hearing to be conducted, which shall be not more than <br />72 hours iexclusine of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony frorn you, City personnel involved in the incident that resulted in this Notice, and other witnesses W the <br />inc The Division Direct or may exclude anyone, other than you and those presenting testa - nony, frorn the in forinal I kearing. <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 time shown above by: <br />(Signamre ofperson Issuing/delivering notice) <br />I hereby acknowledge receipt ofthe above Not on [lie date and time indicated above, <br />(Signature 0/rsollhel g, issued the notice) <br />White Pkjhli(: Work (aecil Copy: File Y allow Copy: Kqlorl, C opy N A t op Res ipieju Gold Copy: Offlicu Apps it nolwe Rev. 04,103 <br />