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z <br />Name: Last First - -A44dffd <br />- Z <br />DO B/ <br />Race, Se <br />Res, A ddress City <br />Sta <br />1 <br />-4 <br />Under the authority of. dministraative 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 />V� Entering in or using all City of Eugene parks, open spaces or facilities. <br />arrested and charged with criminal trespass in the second degree <br />Pursuant to Park and Open Space Rule R-1,(174 you are entitled to an informal hearing to contest this Notice. A request for an <br />informal hearing inust be made in writ. ing and Fled with the Parks & Open Space Division Director ("the Division Director") <br />W I thin 48 hours (exclusive of weekends) of receipt ofthis Notice at the l'oflowing address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the irlforrrial hearing to be conducted, which shall be not more than <br />72 hours fexclusivc ol'weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony 11 you, City personnel involved in the incident that resulted in this Notice, and other witnesses Lo tile <br />incident, The Divisitni Director may exclude anyone, other than you and those presenting testirnorly, frorn the infi, hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person narned at the top of this Notic4t file date and time shown above bv� <br />. .... ...... <br />¢ Slgnavure of perscsn issuing/detivering not�cc <br />I hereby acknowledge receipt ol'Ifie above Notice on the date and tHrie indicated above. <br />(Signature of person being issued the notice) <br />Whiw ( opy. Pubhe Wurkv (3recin ( opy: File Yetlo%a Copy Re pore Copy Pilik Copy: Recipient Gold Copy: Officei Appeal ncynce Rev 04 JR, <br />