Western Australian Consolidated Regulations[r. 5]
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Painters’ Registration Act 1961 |
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 | ||
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Date |
Date of notice / /20 |
|
|
Notice to alleged offender |
It is alleged that you have committed the above offence. | |
|
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 2 — Withdrawal of infringement notice
|
Painters’ Registration Act 1961 |
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The above infringement notice issued against you has been withdrawn. | |