Western Australian Consolidated Regulations[r. 5 and 6]
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Motor Vehicle Dealers Act 1973, s. 55A(3) |
Notice No: | ||||
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Alleged offender |
Family name: | ||||
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Other names: | |||||
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Address |
No.: |
Street name: | |||
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Suburb: |
Postcode: | ||||
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Alleged offence |
Section of the Act: Or Provision of the Regulations: | ||||
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Description of alleged offence: | |||||
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Where and when: | |||||
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Amount of modified penalty |
$ | ||||
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Authorised officer who issued this notice |
Name: | ||||
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Signature: | |||||
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Date: | |||||
Notes
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WHAT YOU MUST DO |
1. You may dispose of this matter within
28 days after the service of this notice by paying the modified
penalty — |
[Form 1 amended in Gazette 12 Jan 2007
p. 49; 30 Jun 2011 p. 2663‑4.]
Form 2
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Motor Vehicle Dealers Act 1973, s. 55A(7) |
Notice No: | ||||
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To [Details of alleged offender] |
Family name: | ||||
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Other names: | |||||
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Address |
No.: |
Street name: | |||
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Suburb: |
Postcode: | ||||
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AN INFRINGEMENT NOTICE SERVED ON YOU HAS BEEN WITHDRAWN.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 ] | |||||
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Details of withdrawn notice |
Date notice given: | ||||
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Alleged notice: | |||||
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Designated official who issued this notice |
Name: | ||||
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Signature: | |||||
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Date: | |||||