Western Australian Consolidated Regulations[r. 10]
[Heading inserted in Gazette 22 Sep 2006
p. 4083.]
Form 1 — Infringement notice
|
Chattel Securities Act 1987 |
Infringement | |
|
Alleged offender |
Name: Family name | |
|
Given names | ||
|
or Company name
____________________________________ | ||
|
Address ________________________________________________ | ||
|
Alleged offence |
Description of offence _____________________________________ | |
|
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 do not pay the modified penalty within 28 days, you may be
prosecuted or enforcement action may be taken under the Fines, Penalties and
Infringement Notices Enforcement Act 1994 . Under that Act your
driver’s licence and/or vehicle licence may be suspended. | |
| |
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. | |
[Form 1 inserted in Gazette 22 Sep 2006
p. 4083.]
Form 2 — Withdrawal of infringement notice
|
Chattel Securities Act 1987 |
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 ____________________________________ | |
|
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The above infringement notice issued against you has been withdrawn.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. 4084.]