Western Australian Consolidated Regulations[r. 19]
[Heading inserted in Gazette 22 Sep 2006
p. 4080.]
Form 1 — Infringement notice
|
Charitable Collections Act 1946 |
Infringement | |
|
Alleged offender |
Name: Family name | |
|
Given names | ||
|
or Company name
____________________________________ | ||
|
Address ________________________________________________ | ||
|
Alleged offence |
Description of offence _____________________________________ | |
|
Charitable Collections Act 1946 s. | ||
|
Date / 20
Time a.m./p.m. | ||
|
Modified penalty $ | ||
|
Officer issuing notice |
Name | |
|
Signature | ||
|
Office | ||
|
Date |
Date of notice / /20 |
|
|
Notice to alleged offender |
It is alleged that you have committed the above offence. If you need more time to pay the modified penalty, you can apply for an
extension of time by writing to the Approved Officer at the above postal
address. If you want this matter to be dealt with by prosecution in court , sign here
_______________________________________ | |
[Form 1 inserted in Gazette 22 Sep 2006
p. 4080.]
Form 2 — Withdrawal of infringement notice
|
Charitable Collections Act 1946 |
Withdrawal no. | |
|
Alleged offender |
Name: Family name | |
|
Given names | ||
|
or Company name
_____________________________________ | ||
|
Address _________________________________________________ | ||
|
Infringement notice |
Infringement notice no. | |
|
Date of issue / /20 | ||
|
Alleged offence |
Description of offence ____________________________________ | |
|
Charitable Collections Act 1946 s. | ||
|
Date / /20
Time a.m./p.m. | ||
|
Officer withdrawing notice |
Name | |
|
Signature | ||
|
Office | ||
|
Date |
Date of withdrawal /
/20 | |
|
Withdrawal of infringement notice |
The above infringement notice issued against you has been withdrawn. | |
[Form 2 inserted in Gazette 22 Sep 2006
p. 4081.]
[Schedule 2 inserted in Gazette
22 Sep 2006 p. 4080-1.]