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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 />Entering in or using all City of Eugene parks, open spaces or facilities, <br />V <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 lark wand Open Space Rule R- 1 .074 you are entitled to an informal hearing to contest this Notice, A reqUest for at] <br />informal hearing must be made in writing and filed with the Parks & Open, Space Division Director ("the Division Director") <br />within 48 hours, (CXC1L1NiVC of "weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule as time and place for the inflortnal hearing to be conducted, which shall be not more than <br />72 hours (eXCIUSIVC ol'weekends) of receipt of' the request for hearing. At the informal hearing the Division Director w iH only <br />consider testimony firorn you, City personnel involved in the incident that resulted in this Notice, and other wrtne%sesto the <br />incident. The Division Director may exclUde anyone, other than you and those presenting testirnony, from the informal hearing. <br />`rhis Notice shall remain in effect pending any requested hearing, <br />This Notice of Fxclusion was delivered to the person named at the top of this Notice at t e' and titne shown above ley: <br />(Signature of - person i",suin notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and tirrie indicated above, <br />(Signature of person being issued the nolice) <br />White ( opy: lublic Works Greull ( opy: Fitc Yetlow ( q)y: Report Colly Pink Copy: RecipLenl Gold Copy: Officer Apjw.i I no6c c Rc 04,10 <br />Narne: Last <br />First <br />Middle <br />DOB� <br />R, ice. xa <br />7 <br />A/v)-Z <br />FZ clv,&/)� <br />C <br />7 <br />Res. Address: <br />C j ty <br />State <br />1 Zip <br />Res. Phone: <br />Work Phone: <br />A, <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 />Entering in or using all City of Eugene parks, open spaces or facilities, <br />V <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 lark wand Open Space Rule R- 1 .074 you are entitled to an informal hearing to contest this Notice, A reqUest for at] <br />informal hearing must be made in writing and filed with the Parks & Open, Space Division Director ("the Division Director") <br />within 48 hours, (CXC1L1NiVC of "weekends) of receipt ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule as time and place for the inflortnal hearing to be conducted, which shall be not more than <br />72 hours (eXCIUSIVC ol'weekends) of receipt of' the request for hearing. At the informal hearing the Division Director w iH only <br />consider testimony firorn you, City personnel involved in the incident that resulted in this Notice, and other wrtne%sesto the <br />incident. The Division Director may exclUde anyone, other than you and those presenting testirnony, from the informal hearing. <br />`rhis Notice shall remain in effect pending any requested hearing, <br />This Notice of Fxclusion was delivered to the person named at the top of this Notice at t e' and titne shown above ley: <br />(Signature of - person i",suin notice) <br />I hereby acknowledge receipt ofthe above Notice on the date and tirrie indicated above, <br />(Signature of person being issued the nolice) <br />White ( opy: lublic Works Greull ( opy: Fitc Yetlow ( q)y: Report Colly Pink Copy: RecipLenl Gold Copy: Officer Apjw.i I no6c c Rc 04,10 <br />