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LOCATION (PAR /OPEN SPACE): <br />you are nervoy <br />dotified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />a <br />The basis for this Notice of Restriction of Use is that on 6 q1 ql_s you v section bjo—(A—�f the Park <br />and Open Space Rules, and/or Section <br />of the Eugene Code, 1971, and/or ORS I To wit, you: <br />M <br />This restriction of use is effective beginning on irg wV115 , and shall remain 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 />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive apt weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from 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 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 ofthi ate and tirne shown above by: <br /># <br />(Si ,nature of person issuin&elivering notice) <br />C, <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />V "715MD <br />(Signature of person being issued the notice) <br />W h it c Cupy : P ub I ic Works Green Copy: File Yello Copy Report Copy Pink Copy: Recipient Gold Copy: Of Appeal nat ice Rcc, 04/03 <br />Nanie: Last FirsMiddle <br />DOB� <br />Race/'Se is <br />Erl-141J 00 <br />� r <br />Re;,, Address: City <br />taSc <br />Zip <br />Req. Pbone: <br />Work Phone: <br />you are nervoy <br />dotified that you are prohibited from (check box): <br />Entering in or using all City of Eugene parks, open spaces or facilities. <br />a <br />The basis for this Notice of Restriction of Use is that on 6 q1 ql_s you v section bjo—(A—�f the Park <br />and Open Space Rules, and/or Section <br />of the Eugene Code, 1971, and/or ORS I To wit, you: <br />M <br />This restriction of use is effective beginning on irg wV115 , and shall remain 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 />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive apt weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from 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 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 ofthi ate and tirne shown above by: <br /># <br />(Si ,nature of person issuin&elivering notice) <br />C, <br />I hereby acknowledge receipt of the above Notice on the date and time indicated above. <br />V "715MD <br />(Signature of person being issued the notice) <br />W h it c Cupy : P ub I ic Works Green Copy: File Yello Copy Report Copy Pink Copy: Recipient Gold Copy: Of Appeal nat ice Rcc, 04/03 <br />