Western Australian Consolidated Regulations Western Australian Consolidated Regulations[bls. 18(3) and 19(1)]
Form 1
Hospitals and Health Services Act 1927
Armadale Kelmscott District Memorial Hospital By‑laws 2002
INFRINGEMENT NOTICE
No. .......................................
Date of service .... / .... / ......
TO: THE OWNER / DRIVER / PERSON IN CHARGE OF VEHICLE
MAKE
................................................ TYPE
........................................................................................................
PLATE NO. ........................................... COLOUR
..............................................................................................
IT IS ALLEGED THAT AT ABOUT .......... HRS ON THE ............ DAY OF
..................................................,
YOU CONTRAVENED THE
BY‑LAW SPECIFIED AND BRIEFLY DESCRIBED AS FOLLOWS:.
..............................................
Authorised person
BY‑LAW NO.
........................................................................................................................................................
DESCRIPTION OF OFFENCE
.............................................................................................................................
.................................................................................................................................................................................
MODIFIED PENALTY
.........................................................................................................................................
You may dispose of this matter either —
(a) by
paying the modified penalty within 28 days of the date you received this
notice, or such further time as an authorised person allows, to the cashier
Armadale Kelmscott District Memorial Hospital or an authorised person,
Armadale Kelmscott District Memorial Hospital; or
(b) by
having it heard and determined by a court.
If the modified penalty is not paid within the period referred to above, court
proceedings may be taken against you. If convicted, you may be liable to a
penalty not exceeding $50.
Payment of the modified penalty is not to be regarded as an admission for the
purposes of any proceedings, whether civil or criminal. Retain the receipt for
proof of payment.
Date ......./......./........
Received from
.................................................................................................….
of
...........................................................................................................................
the sum of $ ............. in payment of the modified penalty referred to
above.
...................................................
Authorised person
Form 2
Hospitals and Health Services Act 1927
Armadale Kelmscott District Memorial Hospital By‑laws 2002
WITHDRAWAL OF INFRINGEMENT NOTICE
Date .... / .... / ......
To:
..........................................................................................................................
of
...........................................................................................................................
Infringement notice No. .............................. served on you on the
................. day of
...........................................................................................................................,
for the alleged offence of
.......................................................................................
................................................................................................................................
is hereby withdrawn and no further action will be taken against you in respect
of the alleged offence.
If you have paid the modified penalty before receiving this notice, the amount
of the payment will be refunded to you on presentation of the receipt issued
by the cashier or an authorised person of the Armadale Kelmscott District
Memorial Hospital for the payment.
.................................................
Authorised person