Western Australian Consolidated Regulations

CENSORSHIP REGULATIONS 1996 - SCHEDULE 2

[r. 4 and 5]

Form 1

Censorship Act 1996 s. 117E(1) Infringement Notice				Notice No:
Alleged offender	Family name:
	Other names:
	Address:	No.:	Street name:
		Suburb:			Postcode:
Alleged offence	Details of alleged offence:
	Description of alleged offence:
	Where and when:
Amount of modified penalty	$
Police officer who issued this notice	Name:
	Signature:
	Date:

What you must do

1.         You may elect to have this matter heard and determined by a court. To do this, complete the details in “ Electing action by a court ” on the reverse of this notice and return this notice to [details to be inserted here] within 28 days after the service of this notice. 2.         If you do not wish to have this matter heard and determined by a court you may dispose of this matter within 28 days after the service of this notice by paying the modified penalty (see “ Paying the modified penalty ” on the reverse of this notice). Should you not pursue either of the above options within 28 days, additional administrative charges may be incurred and action may be taken to suspend your Motor Driver’s Licence until you have paid in full the modified penalty and any additional charges OR you have elected to have this matter dealt with before a Court.

Reverse of Form 1

Electing action by a court	I elect to have the offence alleged in this notice dealt with by a court. I understand that I may receive a summons for the alleged offence.
	Signature:
	Date:
	Address for service:

Paying the modified penalty

You may pay the modified penalty — 1.         BY POSTING a cheque or money order made payable to [details to be inserted here]; OR 2.         IN PERSON to [details to be inserted here].

Form 2

Censorship Act 1996 s. 117G(1) Withdrawal of Infringement Notice				Notice No:
To [Details of alleged offender]	Family name:
	Other names:
	Address:	No.:	Street name:
		Suburb:			Postcode:
AN INFRINGEMENT NOTICE SERVED ON YOU HAS BEEN WITHDRAWN. ANY PAYMENT THAT HAS BEEN MADE WILL BE REFUNDED AND — ι         NO FURTHER ACTION WILL BE TAKEN* ι         A SUMMONS WILL BE ISSUED* [* delete whichever is not applicable ]
Details of withdrawn notice	Date notice given:
	Notice number:
	Alleged offence:
Authorised person who issued this notice	Name:
	Signature:
	Date:

        [Schedule 2 inserted in Gazette 4 Jun 2004 p. 1931‑2.]