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M11 e Last <br />e <br />art k ' <br />DOB� R,-we/Sex: <br />R es, Ad d r e s s <br />City State Zip I Res. Phone: Work 1 <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), you are herebV <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />C The basis for this Notice of Restriction of Use is that on -7j4---,,,----,you violated Section of the Park <br />and Open Space Rules, arid/or Section of the Eugene Code, 197 t, and/or ORS To wit, You: <br />UjK-1 Ptssefs <br />(Description of the violation.) <br />If you enter in or use any Cnv of Eugene park., open sp =ace or facility during the effective period of this Notice, you nria I. <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and Open Space hate R-1,074 you are entitled to an infortrial hearing to contest this Notice. A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 48 11013rs (CXChJsiVC of weekends) of receipt of this Notice at the following address, 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. 'rhe Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice cif Exclusion was delivered to the person named at the top ofthisNotice at the date and firne shown above by: <br />..... . . . ... <br />(Signature of person issuing/ciefivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature offierson being issued the notice) <br />Whtle Cop y: Pubfic Work, Grm Cupy: File Yelfow Copy Repon Copy Pink Copy: Recipiew Gad Copy: Offico Appc�o rm�j� e Rc%, WAR <br />