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Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-1.005(3), you are hereby <br />notified you are prohibited from (check box ): <br />7 Entering in or using all City of Eugene parks, open spaces or facilities. <br />AM <br />The basis for this Notice of Restriction of Use is that on IW you violated Section the Park <br />Nu to Park and Open Space Rule R-1 .074 you are entitled to an informal hearing to contest this Notice, A request fior an <br />informal hearing must be made in writing and filed with the Parks, & Open Space Division Director "the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Dines for shall schedude -11 time and place l or the informal hearing to be condLiCted, which shall be not n than <br />72 hours (exclusive of weekends) ofreceiptart the request for hearing. At the inibri hearing the Division Director wHI only <br />consider testimony 1 you, ('Ity 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 testirnony, from the informal hearni <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice awl` Exclusion was delivered to the 1,wi marred at the top of this Notice al I, ate and 1 shown above by: <br />1� Lire of pet-son issuing/defivering noLice) <br />I hereby acknowledge receipt of the above Notice on the &ate and tune indicated above. <br />(Signature ol"person being issued the notice) <br />Wlike Copy: 1 ublic Works Gleen Copy Filc Y��.[Iow Uoin . Repom Copv Pink Copv Recipient Gold ( opY: Officer Ap5ie.d rjolice Rc 04 1 0` � <br />Norte Lasl First Middte <br />DOB: <br />Rata/," �X: <br />C 4 <br />I <br />fees.. dd City <br />ress� <br />— <br />St <br />Zip <br />1 <br />Phone: <br />WmI llhone� <br />z <br />Under the authority of Administrative Order No. 58-03-24-Fand Park and Open Space Rule R-1.005(3), you are hereby <br />notified you are prohibited from (check box ): <br />7 Entering in or using all City of Eugene parks, open spaces or facilities. <br />AM <br />The basis for this Notice of Restriction of Use is that on IW you violated Section the Park <br />Nu to Park and Open Space Rule R-1 .074 you are entitled to an informal hearing to contest this Notice, A request fior an <br />informal hearing must be made in writing and filed with the Parks, & Open Space Division Director "the Division Director") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Dines for shall schedude -11 time and place l or the informal hearing to be condLiCted, which shall be not n than <br />72 hours (exclusive of weekends) ofreceiptart the request for hearing. At the inibri hearing the Division Director wHI only <br />consider testimony 1 you, ('Ity 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 testirnony, from the informal hearni <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice awl` Exclusion was delivered to the 1,wi marred at the top of this Notice al I, ate and 1 shown above by: <br />1� Lire of pet-son issuing/defivering noLice) <br />I hereby acknowledge receipt of the above Notice on the &ate and tune indicated above. <br />(Signature ol"person being issued the notice) <br />Wlike Copy: 1 ublic Works Gleen Copy Filc Y��.[Iow Uoin . Repom Copv Pink Copv Recipient Gold ( opY: Officer Ap5ie.d rjolice Rc 04 1 0` � <br />