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LOCATION WARK/OPEN SPACE): <br />-)6 <br />Fi• -,t ARL'nW Micidle DOB: <br />Race"Sex: i <br />6TF <br />r"4�A CA14— r 2 — C h <br />LQ Res, A C di <br />C4 City State Zip Res�, pkmle: Work Plmne- <br />Under the authority of Administrailive Order No. 58-03-24-F and Parka an Open tree Rule R-1-005(3), you are hem- by notified that you are prohibited from (check box): <br />�E ntering in or using all City of Eugene parks, open spaces or facilities. <br />El <br />I'he basis for this Notice of lZestriction of Use is that or, I-V 1,01004) <br />you violated Section of tile Park <br />If you enter in or use anN <br />! City of Eugene park, open space or fa, <br />arrested and charged with criminal trespass in the second degree, <br />Pursuant to Park and Open Space Rule 1 -1,074 you are entitled to an informal hearing to contest this Notice, A rCuUCSI f6l- all <br />informal hearing must be made in writing a d filed with the Parks &- Open Space D i vision Director ("the Division Director") <br />within 48 hours (exclusive of 'weekends) of receipt ol"this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, Oil <br />97402. <br />The Division Director shall schedule a time and place km the ird'ormal hearing to be conducted, whicl-I shall be not more than <br />72 hours (exclusive of'weekends) of receipt of the request for hearing. At the infornia I hearing the Division Director will only <br />consider testimony from you, City personnel involve(] 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 testimony, froni the informal hearing, <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice ofk'xclusion was delivered to the person named at the top of this Notice at the date and time shown above bv: <br />ignature of person i,ssuing/del ivering notice) <br />4�1 <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above, <br />(,Signature of person being issued the notice) <br />Mme Copy Public Woll", G e�m oj' : Fil, YeHow Copa : Report Copy Pink Cop} R ccipient GOId ( Oflial Apjpe�d rwlicc Rec, 04!03 <br />