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LOCATION (PARK/0PEN SPACE): C er\&\C &wc <br />Name- LaqL ir Mid(fle DOB: Rau /Sex: <br />01 <br />)S C l <br />ON ( <br />Res, Address: City stt110 zip Res. flhone Work thorn:: <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 front (clieck box}- <br />Entering in or using all City of Eugene parks, open spaces fw facilifies. <br />If you enter in or use any City oil' Eugene park, open space or facility during the cffectic, period of this Notice, you may be <br />arrested and charged with criannal trespass in the second degree. <br />pursuant to Park and Open Space IZUle R -1.074 YOU are entitled to an inf'orinal hearing to contest this Notice. A reqLWSI for all <br />infonrial hearing rriust be made in writing and filed with the Parks & Open Sl,.)ace Division Director ("the Division Director" ' <br />within 48 hours (exclusive of weekends) of receil..it of this Notice at the fo,l [owing oiddress 1820 Roosevelt, Blvd., Eugene, Oil <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, �xhich shall be not more than <br />72 hours (excIUSive of weekends) of receipt of the request for hearing, At the infibrinal hearing the Division Director will only <br />4D <br />coms.ider testimony firom, you, (-'try personnel involved in the incident that resulted in this Notice, and other witnesses io the <br />incident. The Division Director tnay exclude anyone, other than you and those presenting restin frorn the informai headng, <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 tinie shown above by: <br />, z C_ <br />(Signature offierson Issuing/delivering notice) <br />I hercbv acknowledge receipt ofthe above Notice on the date An(,] time indicated above, <br />(Signature of person being issued the notice <br />Whih, ( opy: Public Wmks G � (, en ( ol "Y - 1 i l C Yellow Cup.y: 6 cport ( opy Nuk Copy: Rccipwn� Gold Copy Officex Appc�l nohcc Re 0410l <br />