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NOTICE OF RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE f TIME: �V CASE <br />LOCATION (PARKJOPEN SPACE): L <br />Under the authority of Administrath Order No. 58-03-24-F 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 />This restriction of use is effeetive beginning on ' d an shall remain in effect until <br />0 0 0 '� <br />The Division Director shall schedule a time and place for the inforinal hearing to be conducted, which shall be not more th <br />72 hours I ' exclusive of weekends) of"t of the request for hearin04. At the infbimal earin t , he Division Director will onj <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other wit:nesses to t <br />rn� incident, The Division Director m_av exclude anyone. other than you and those Y-resentin testimQn . from the info jal :h:alrin <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, issuing/delivering notice) <br />11 1 <br />On I I ii <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold C opy: Officer Appeal notice Rev. 04 03 <br />Name: La First Middle <br />DOB. <br />Race;Se"�- <br />z <br />Ir K, I <br />W <br />4 <br />Res. Address: City <br />tate <br />ip <br />RA, Phone: <br />Work Are: <br />Under the authority of Administrath Order No. 58-03-24-F 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 />This restriction of use is effeetive beginning on ' d an shall remain in effect until <br />0 0 0 '� <br />The Division Director shall schedule a time and place for the inforinal hearing to be conducted, which shall be not more th <br />72 hours I ' exclusive of weekends) of"t of the request for hearin04. At the infbimal earin t , he Division Director will onj <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other wit:nesses to t <br />rn� incident, The Division Director m_av exclude anyone. other than you and those Y-resentin testimQn . from the info jal :h:alrin <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, issuing/delivering notice) <br />11 1 <br />On I I ii <br />(Signature of person being issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient Gold C opy: Officer Appeal notice Rev. 04 03 <br />