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LOCATION (PARK/OPEN SPACE): W A-!SO40 -" F ( - <br />Under the authority of Administrative Order No. 58-03-24-Y and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) <br />U3 - j - V 1AIZ14 <br />1 I-1,11x7c -1) T;L�j <br />This restriction of use is effective beginning on C's vE k <br />:,Qnd shall remain in effect until a <br />C6 -r <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 informal 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 of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />Z- HULLIb k UXUILLSIVU M WUMCHUS) 01 recelpt 01 LIX ICLJUC�IL 11 V! ming. 1 4 1 1 [it �1 I nearing me �w VoSion <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 infartnal 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 iisuing/detivering notice") <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of pens b 'nl issued the notice) <br />White Copy: Public Works Green Copy: File YeUow Copy: Report Copy Pink Copy: Recipient Gotel Copy: Officer Appeal notice R,Zv. 04,03 <br />Name! First iddle <br />DOB: <br />z <br />o <br />VN11\ <br />Res. Address: City <br />State <br />Zip <br />Res, lybo= <br />Work Phone: <br />Under the authority of Administrative Order No. 58-03-24-Y and Park and Open Space Rule R-1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />(Description of the violation.) <br />U3 - j - V 1AIZ14 <br />1 I-1,11x7c -1) T;L�j <br />This restriction of use is effective beginning on C's vE k <br />:,Qnd shall remain in effect until a <br />C6 -r <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 informal 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 of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />Z- HULLIb k UXUILLSIVU M WUMCHUS) 01 recelpt 01 LIX ICLJUC�IL 11 V! ming. 1 4 1 1 [it �1 I nearing me �w VoSion <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 infartnal 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 iisuing/detivering notice") <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />(Signature of pens b 'nl issued the notice) <br />White Copy: Public Works Green Copy: File YeUow Copy: Report Copy Pink Copy: Recipient Gotel Copy: Officer Appeal notice R,Zv. 04,03 <br />