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b 6U*04 <br />NOTICE OF RESTRICTION V <br />and Notice of Right to Appeal <br />DATE� s' TIME: <br />__tq CASE 4: <br />LOCATION (PARK/OPEN SPACE): C _k <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), yap u are herebN <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />171 <br />(Description of the violation.) <br />This restriction of use is effective beginning on I 'DLe; rid shall reinain in effect until C) <br />If you enter in or use any City of Eugene park-, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />s (exclusive ()I I vC1z.'1PL 01 1111's o'UticV UL LILC Luflowing, <br />97402. <br />consider testimony from you, City 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 testimony, from the infomnal 'hearin <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Exclusion was delivercd to the person named at the top of this Notice at the date and time shown above by: <br />(Signature of "person issuing/delivering notice) <br />(Signature of pers;b�nveing issued the notice) <br />White Copy: Pubfic Worb Green Copy: File 5 ellow Copy: Report Copy Pink Copy! Recipient Gold Copy: Of Appeal nofice Rev- CW03 <br />Name: La. First Middle <br />DOB: <br />Race/Sex. <br />z <br />yVX cs/1 C <br />9t <br />Res-1 Addr 1161'. city <br />State <br />Zip <br />Reg, Phone: <br />Work Phone <br />Under the authority of Administrative Order No. 58-03-24-F and Park and Open Space Rule R-1.005(3), yap u are herebN <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />171 <br />(Description of the violation.) <br />This restriction of use is effective beginning on I 'DLe; rid shall reinain in effect until C) <br />If you enter in or use any City of Eugene park-, open space or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the second degree. <br />s (exclusive ()I I vC1z.'1PL 01 1111's o'UticV UL LILC Luflowing, <br />97402. <br />consider testimony from you, City 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 testimony, from the infomnal 'hearin <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of'Exclusion was delivercd to the person named at the top of this Notice at the date and time shown above by: <br />(Signature of "person issuing/delivering notice) <br />(Signature of pers;b�nveing issued the notice) <br />White Copy: Pubfic Worb Green Copy: File 5 ellow Copy: Report Copy Pink Copy! Recipient Gold Copy: Of Appeal nofice Rev- CW03 <br />