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notified (hat you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or faciliti(M <br />0 <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 />Pursuant to Park and Open Space Rule R - you are entitled to an info al 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 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division D irector shall schedule a time and place for the informa I hearing to be conducted, whi ch shal I be not more than <br />72 hmirs (exclusive of weeken ii o i i ecei i t of the re i ucit for hearmi, At the infonnal hearima the Division Director will Univ <br />777nsi er testimony num y7u, - ity pL:,i 6UHAJU� JHVUIVUU III UIC 111LAMM UJUL IUSLULCU III MIS INMIUL�, aHU UUM Wit <br />incident. The 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 of Exclusion was delivered to the person named at the top ofthis Notice at the date and time shown aabove by- <br />A/l (, - t <br />(Sign <br />of person is noocc) <br />c <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 />Whine Copy: Public WorLr Gru4n Copy: Fi Yellow Copy! Refwrt Copy Pink Copy Recipient Gold Copy: Officer Appeal not ice Rev, 04MA <br />Nanie� Last First Middle <br />DOB <br />ftaee/se <br />0 <br />U <br />Res- Address: take <br />Zip <br />Rn Phone: <br />Work Phone: <br />notified (hat you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or faciliti(M <br />0 <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 />Pursuant to Park and Open Space Rule R - you are entitled to an info al 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 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division D irector shall schedule a time and place for the informa I hearing to be conducted, whi ch shal I be not more than <br />72 hmirs (exclusive of weeken ii o i i ecei i t of the re i ucit for hearmi, At the infonnal hearima the Division Director will Univ <br />777nsi er testimony num y7u, - ity pL:,i 6UHAJU� JHVUIVUU III UIC 111LAMM UJUL IUSLULCU III MIS INMIUL�, aHU UUM Wit <br />incident. The 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 of Exclusion was delivered to the person named at the top ofthis Notice at the date and time shown aabove by- <br />A/l (, - t <br />(Sign <br />of person is noocc) <br />c <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 />Whine Copy: Public WorLr Gru4n Copy: Fi Yellow Copy! Refwrt Copy Pink Copy Recipient Gold Copy: Officer Appeal not ice Rev, 04MA <br />