Western Australian Consolidated Regulations

WA COUNTRY HEALTH SERVICE BY-LAWS 2007 - SCHEDULE 3

[bl. 18 and 19]

1 .         Form 1: Infringement Notice (by‑law 18)

WA Country Health Service By‑laws 2007 Infringement Notice			Notice No:
Hospital or Health Service site	Name
Vehicle	Make
	Model
	Plate no.	Colour
Alleged offence	Description of offence ……………………………………………….. ………………………………………………………………………...
	By‑law
	Date and time ………/……../20……. …………….a.m./p.m.
	Modified penalty $
Issuing officer	Name
	Signature
	Date ………/……../20…….
What you must do	You have 28 days from when this notice was given to you to pay the modified penalty or elect to go to court. If you don’t, enforcement proceedings will be taken against you. To pay the modified penalty  — By post:         Send your payment to — WA Country Health Service PO Box 6680 East Perth Business Centre WA 6892 In person:         Pay the cashier at one of the WA Country Health Service’s hospitals. To elect to go to court , sign this Notice here ….………………………………………………………………….. then send it to the Chief Executive Officer of the WA Country Health Service at the above address. Make sure you keep a copy. If you go to court and are convicted you may be fined $50 and ordered to pay costs. If enforcement proceedings are taken against you, your driver’s licence and/or vehicle licence may be suspended until you pay the modified penalty and expenses or you elect to go to court.

2 .         Form 2: Withdrawal of Infringement Notice (by‑law 19)

WA Country Health Service By‑laws 2007 Withdrawal of Infringement Notice		Notice No:
To [Person to whom Infringement Notice was issued]	Family name
	Other names
	Address .……………………………………………………………… …………..…………………………………………………………….
Infringement Notice	Infringement Notice No.
	Hospital/Health Service site
	Date of issue ………/……../20…….
	Alleged offence ….…..………………………………………………. ………………………………………………………………………...
	Vehicle plate no.
The Infringement Notice has been withdrawn. If you paid the modified penalty before the Infringement Notice was withdrawn, take your receipt and this notice to the cashier at one of the WA Country Health Service’s hospitals and your payment will be refunded.
Notice withdrawn by	Name
	Signature
	Date ………/……../20…….