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Xle't id—V CAL nuC Ust—uld"k "17 ITCH <br />and Notice of Right to Appeal <br />DATE: 0�4 `1 7> TIME: I-Soo CASE #: <br />LOCATION (PARK/OPEN SPACE): <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 />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. Arequestforan <br />informal 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 />nualstexclUSIVU01 WtxrCl1UN) U1 RuCcipt vi NIF i7quM 101 11911CULUL will T <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to tl�e <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 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- In being issued (Signature of pper g issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink- Copy: Recipient Gold Copy: Off - wer Appeal notice Rev, 04/03 <br />Name: Lyt First Middle <br />El. <br />Race/Sex <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />.. . ......... .. <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 />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. Arequestforan <br />informal 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 />nualstexclUSIVU01 WtxrCl1UN) U1 RuCcipt vi NIF i7quM 101 11911CULUL will T <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to tl�e <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 issuing/delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />- In being issued (Signature of pper g issued the notice) <br />White Copy: Public Works Green Copy: File Yellow Copy: Report Copy Pink- Copy: Recipient Gold Copy: Off - wer Appeal notice Rev, 04/03 <br />