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W51"A"',1A <br />Under the authority of Administrative 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 />X <br />The basis for this Notice of Restriction of Use is that on �B , you violated Section <br />of the Eugene Q)de, 1971, andJor ORS <br />and Open Space Rules, and/or SectionA,—LOI- <br />4 k 1 , � 5 <br />AA444 lK4,0iie71 <br />MAHMOM <br />To wit, you:_ <br />-emain in effect until A IJ.2 & / <br />during the effective period of this Notice, you may be <br />97402. <br />72 hotts f.exclusive of weekends'� of recei%t of the reAuest for hearin . At the infa mal hearinp the Division Director will ow <br />consider testimony ftorn 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 vou 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 d and time shown above by: <br />= 4 3�is <br />(Signature 6Arson issuing/delivering notice) <br />ED <br />I hereby acknowledge receipt of the above Notice on the date and time indicated <br />White COpy Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient <br />MM <br />Nanje: Last F i r':" <br />ALddle <br />DOB: <br />gp <br />13'7 <br />Res, Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />W51"A"',1A <br />Under the authority of Administrative 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 />X <br />The basis for this Notice of Restriction of Use is that on �B , you violated Section <br />of the Eugene Q)de, 1971, andJor ORS <br />and Open Space Rules, and/or SectionA,—LOI- <br />4 k 1 , � 5 <br />AA444 lK4,0iie71 <br />MAHMOM <br />To wit, you:_ <br />-emain in effect until A IJ.2 & / <br />during the effective period of this Notice, you may be <br />97402. <br />72 hotts f.exclusive of weekends'� of recei%t of the reAuest for hearin . At the infa mal hearinp the Division Director will ow <br />consider testimony ftorn 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 vou 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 d and time shown above by: <br />= 4 3�is <br />(Signature 6Arson issuing/delivering notice) <br />ED <br />I hereby acknowledge receipt of the above Notice on the date and time indicated <br />White COpy Public Works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient <br />MM <br />