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Lender the authority of administrative Carder No. 58-03-24-F and :Park and Open Space Jule - 1.005(3 ), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or rising all City of Eugene parks, open spaces or facilities. <br />Ire <br />The basis for this Notice of Restriction of Use is that on y ou violated Section fthe Park <br />and Open Space Rules, and /or Section of the Eugene Code, 1171, and /or ORS To wit., you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on , and shall retrain 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 degree. <br />Pursuant to Park and Open Space Rule R- 1.074 you are entitled to an informal hearing to contest this Notice A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 49 hours, (excln. of wee lqlanseve& H1.1- <br />RM .— Y 11-M y —, -- prIS01111M Hivorviyo in Tne 171cM7 IT7177=7eu s oic n o ner -M <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, frorn the informal hearin <br />This Notice shall remain in effect pen; <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 />.__ <br />erson su <br />(Signature of ping. delivering notice) <br />I hereby acknowledge receipt of the above Notice can the (late and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: public Works Green Copy: File Yeflow Copy! Report Copy [sink. Copy: Recipient Gold Copy: Officer Appeai notice Rev. 04,103 <br />Na e: Last First Middle <br />DOB. <br />dace /Seat: <br />Ices. address: City <br />State dip <br />Ices. Phone: <br />Work Phone: <br />Lender the authority of administrative Carder No. 58-03-24-F and :Park and Open Space Jule - 1.005(3 ), you are hereby <br />notified that you are prohibited from (check box): <br />Entering in or rising all City of Eugene parks, open spaces or facilities. <br />Ire <br />The basis for this Notice of Restriction of Use is that on y ou violated Section fthe Park <br />and Open Space Rules, and /or Section of the Eugene Code, 1171, and /or ORS To wit., you: <br />(Description of the violation.) <br />This restriction of use is effective beginning on , and shall retrain 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 degree. <br />Pursuant to Park and Open Space Rule R- 1.074 you are entitled to an informal hearing to contest this Notice A request for an <br />informal hearing must be made in writing and filed with the Parks & Open Space Division Director ("the Division Director") <br />within 49 hours, (excln. of wee lqlanseve& H1.1- <br />RM .— Y 11-M y —, -- prIS01111M Hivorviyo in Tne 171cM7 IT7177=7eu s oic n o ner -M <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, frorn the informal hearin <br />This Notice shall remain in effect pen; <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 />.__ <br />erson su <br />(Signature of ping. delivering notice) <br />I hereby acknowledge receipt of the above Notice can the (late and time indicated above. <br />(Signature of person being issued the notice) <br />White Copy: public Works Green Copy: File Yeflow Copy! Report Copy [sink. Copy: Recipient Gold Copy: Officer Appeai notice Rev. 04,103 <br />