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z <br />L� <br />Narne: Last First Middle <br />DOB: <br />Race/SeX4 <br />Res. Address: City <br />State, Zip <br />Res, Phone: <br />Work Phone: <br />I if i 1- <br />0 9­7 q031 <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 />Entering in or using all City of Eugene parks, open spaces or facilities <br />The basis for this Notice of Restriction of Use is that on 03 a9 I e Par) <br />you violated Section of th <br />and Open Space Rules, andlor Section <br />r--1v <br />(Description of the violation,) <br />of the Eugene Code, 1971, and/or ORS <br />To wit, you:_ <br />I (-" u � <br />This restriction of use is effective beginning on 0 <br />�91 and shall remain in effect until Iq <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 - you are entitled to an infra al 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 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />M — <br />- <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 infon hearing, <br />This Notice shall remain in effeet 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 -son issuing/delivering notice) <br />� k <br />I hereby acknowledge receipt ofthe above Notice on the date and time indicated above. <br />— - - — — ------ — ------------- <br />(Signature 6 being issued the notice) <br />White L opy: N blic Works Green Copy File Yellow Copy: Repurt Copy Pink Copy: Pecipient Gold Copy: Officer Appea! notice Rev. 041)3 <br />