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?cn- L t 0 r 5 <br />( 16FS3 <br />LOCA (PARK/OPEN SPACE) <br />U nder the authority of Administrative Order No. 58-03-24- F and Park and Open S pace Rule R- 1.005(3 , you are hereby <br />n otified that you a re prohibited from (chec box <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />Pursu ant to Park and Open Space Ru le Fl -1.07 you are entitled to an informal heariDg to contest this N otice.. A request for an <br />informal hearing must be made in writing axed filed with the Parks & Open Space Division Director ("the Division Directoe' i ) <br />within 48 hours (CXCILI!qiVC of weekends) of receipt of this Notice at the fiollowing address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />This Notice qhall 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 date and tim town aboveby. <br />Sr defive <br />,na u c o person issuingi ring nowc) <br />I hereby acknowledge receipt of the above Notice on the date and th indicated above. <br />(Signature of'person being issued the notice) <br />Whae Copy Public Works Green Copy: He - YelbDw Cop Rvpon Copy Pink Copy: Rievipiew Gdd C(,T, Officer App�.d motwL Rcv- W03 <br />Name: Last First Middle <br />DO <br />LVAW <br />W <br />T <br />Res. Address: City <br />State <br />Zip <br />Res. Phone: <br />Work Phone: <br />r� <br />--- <br />U nder the authority of Administrative Order No. 58-03-24- F and Park and Open S pace Rule R- 1.005(3 , you are hereby <br />n otified that you a re prohibited from (chec box <br />Entering in or using all City of Eugene parks, open spaces or facilities, <br />Pursu ant to Park and Open Space Ru le Fl -1.07 you are entitled to an informal heariDg to contest this N otice.. A request for an <br />informal hearing must be made in writing axed filed with the Parks & Open Space Division Director ("the Division Directoe' i ) <br />within 48 hours (CXCILI!qiVC of weekends) of receipt of this Notice at the fiollowing address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />This Notice qhall 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 date and tim town aboveby. <br />Sr defive <br />,na u c o person issuingi ring nowc) <br />I hereby acknowledge receipt of the above Notice on the date and th indicated above. <br />(Signature of'person being issued the notice) <br />Whae Copy Public Works Green Copy: He - YelbDw Cop Rvpon Copy Pink Copy: Rievipiew Gdd C(,T, Officer App�.d motwL Rcv- W03 <br />