Western Australian Consolidated Regulations[r. 14]
[Heading inserted in Gazette 24 Jun 2008
p. 2831.]
Form 1
|
Motor Vehicle Repairers Act 2003 , s. 101(1) |
Infringement | |
|
Alleged offender |
Name: Family name | |
|
Given names | ||
|
or Company name
____________________________________ | ||
|
Address _________________________________________________ | ||
|
Alleged offence |
Description of offence ______________________________________ | |
| |
Motor Vehicle Repairers Act 2003 s. | |
| |
Date / /20
Time a.m./p.m. | |
|
Modified penalty $ | ||
|
Authorised officer issuing notice |
Name ______________________________________ | |
|
Date |
Date of notice / /20 |
|
|
Notice to alleged offender |
It is alleged that you have committed the above offence. | |
| |
How to pay | |
| |
In person: Present this notice and your payment to the cashier at: | |
| |
If you need more time to pay the modified penalty, you can apply for an
extension of time by writing to: | |
[Form 1 inserted in Gazette 24 Jun 2008
p. 2831-2; amended in Gazette 30 Jun 2011 p. 2665-6.]
Form 2
|
Motor Vehicle Repairers Act 2003 , s. 103(1) |
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 ______________________________________ | |
|
Motor Vehicle Repairers Act 2003 s. | ||
|
Date / /20
Time a.m./p.m. | ||
|
Person giving this notice |
Name | |
|
______________________________________ | ||
|
Date |
Date of withdrawal /
/20 | |
|
Withdrawal of infringement notice |
The above infringement notice issued against you has been withdrawn. | |
[Form 2 inserted in Gazette 24 Jun 2008
p. 2832-3; amended in Gazette 30 Jun 2011 p. 2666.]