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III I ! I ligi Ili! I I I q I <br />III ! 1 11 IBM III Will 1! 1 <br />k 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 10 COY) ofthe Park <br />you violated Section 1.0 <br />and Open Space Rules, an&or Section of the Eugene Code, 197 ], and/or OR S To wit, you <br />J_ <br />. 5 Y� <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 (eXCILISiVe 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, 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 of this Notice at the date and time shown above by: <br />(Signature of person iSSLIling/defivering 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 />White copy: Public works GM Fdu YcIlow Copy: Rqmrt cony Pink Cupy; Rc6picnt Gold Copy, Offivcr Appeal nofi " Rl,:V- (4/03 <br />Nand; Last First Middle <br />DOB� <br />RaceiSe <br />4 <br />'qp# <br />C'3 C- <br />Req. Address,: City <br />State <br />I Zip <br />Res. Phone: <br />Work Phone: <br />III I ! I ligi Ili! I I I q I <br />III ! 1 11 IBM III Will 1! 1 <br />k 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 10 COY) ofthe Park <br />you violated Section 1.0 <br />and Open Space Rules, an&or Section of the Eugene Code, 197 ], and/or OR S To wit, you <br />J_ <br />. 5 Y� <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 (eXCILISiVe 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, 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 of this Notice at the date and time shown above by: <br />(Signature of person iSSLIling/defivering 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 />White copy: Public works GM Fdu YcIlow Copy: Rqmrt cony Pink Cupy; Rc6picnt Gold Copy, Offivcr Appeal nofi " Rl,:V- (4/03 <br />