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Under the authoritv of Ad; a d pen Space Ruie R-1_.005(3), you are FLFFFFT <br />notified that you are prohibited from (cheek box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on CY5 , you violated Section - of the Park <br />and Open Space Rules, and/or Section f jj 40 of the Eugene Code, 1971, and/or ORS . To wit, you __ <br />( Description of the violation.) <br />This restriction of use is effective beginning on03__At___15_, and shall remain in effect until <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 dcgree. <br />Pursuant to Park and Open Space Rule: ® you are entitled to an info al hearing to contest this Notice. A request for an <br />info al 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 ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place flor the info jai hearing to be conducted, which shall be not more than <br />TZ hours (exclusive of weekends) of receipt of the request for hearing. At the info al hearing the Division Director wi only <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 informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person narned at the top of this Notice at the date and time shown above by- <br />--- ------------- <br />(Signature of person 1,"Lfing/delivering notice) <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 />Whi le Copy; P1 b I i 0 Work a Green Copy: File Ye I I ow Copy: Repo n Copy <br />Pink Copy: Recipient Gold Copy; Officerkppcal notice <br />Rc,, <br />Name: Last First Middlt <br />DOB: <br />LU <br />Q� <br />R ey. A d d r c City <br />State <br />Zip <br />Res. Phone <br />Work Phonc: <br />TJQAP--T-C <br />Under the authoritv of Ad; a d pen Space Ruie R-1_.005(3), you are FLFFFFT <br />notified that you are prohibited from (cheek box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on CY5 , you violated Section - of the Park <br />and Open Space Rules, and/or Section f jj 40 of the Eugene Code, 1971, and/or ORS . To wit, you __ <br />( Description of the violation.) <br />This restriction of use is effective beginning on03__At___15_, and shall remain in effect until <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 dcgree. <br />Pursuant to Park and Open Space Rule: ® you are entitled to an info al hearing to contest this Notice. A request for an <br />info al 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 ofthis Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place flor the info jai hearing to be conducted, which shall be not more than <br />TZ hours (exclusive of weekends) of receipt of the request for hearing. At the info al hearing the Division Director wi only <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 informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person narned at the top of this Notice at the date and time shown above by- <br />--- ------------- <br />(Signature of person 1,"Lfing/delivering notice) <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 />Whi le Copy; P1 b I i 0 Work a Green Copy: File Ye I I ow Copy: Repo n Copy <br />Pink Copy: Recipient Gold Copy; Officerkppcal notice <br />Rc,, <br />