Western Australian Consolidated Regulations[r. 19]
Form 1
Western Australia
Casino Control Act 1984 , s. 29I
INFRINGEMENT NOTICE
No: .....................
Date of Service: ............................
|
1. |
To:
...........................................................................................................
of
.............................................................................................................
It is alleged that at about ..................... a.m./p.m. on the
............. day of .................................................., at
......................................................
.................................................................................................................
(name of premises) you committed the offence described below and are liable for the modified
penalty stated. .................................................... of Western Australia |
|
2. |
Section |
Description of offence |
Modified penalty |
|
|
|
3. |
If for any reason you wish to have the matter determined in a court hearing
you need not reply and may decline to pay the modified penalty, but in that
case court proceedings may be taken against you and you may be liable both for
costs and a fine for the offence. |
|
4. |
You may pay the modified penalty within 28 days of the date of this
notice, but if the modified penalty is not then paid you will be deemed to
have declined to pay it and court proceedings may be taken. |
|
5. |
Payment may be made by completing item 6 and either — (a)
posting this form and a cheque, money order or postal note for the amount of
the modified penalty specified in item 2, to the Gaming and Wagering
Commission, P.O. Box 6119, East Perth, W.A. 6892; or (b)
delivering this form and paying the amount to the Gaming and Wagering
Commission, 1 st Floor, Hyatt Centre, 87 Adelaide Terrace, Perth, W.A. 6000. |
|
6. |
I,
..............................................................................................................
(name) of
............................................................................................................
(number and street) .................................................................................................................
agree to pay the modified penalty for the offence indicated in this form. ....................................... (Signature of offender) |
* Delete whichever is inapplicable
[Form 1 amended in Gazette 30 Jan 2004
p. 413.]
Form 2
Western Australia
Casino Control Act 1984 , s. 29K
WITHDRAWAL OF INFRINGEMENT NOTICE
No: .....................
Date of Service: ............................
|
To:
......................................................................................................................
(name) of
........................................................................................................................
(address) Infringement notice No.: .................... served on you on the
.............. day of ................................................... of Western Australia |
|
Section |
Description of offence |
Modified penalty |
|
|
[Form 2 amended in Gazette 30 Jan 2004
p. 413.]