1 . Infringement notice (r. 43(1))
Planning and Development Act 2005 s. 229 |
Infringement notice | |||||
Alleged offender |
Family name | | ||||
Given names | | |||||
Address |
| |||||
Date of birth | |
Male/Female | ||||
Driver’s licence |
No.: State/Country:
| |||||
Description of alleged offence |
Date | |
Time | | ||
Place | | |||||
Details 1 | | |||||
Law contravened | ||||||
Relevant planning document 2 [Tick one box and insert other details] |
□ Planning scheme □ Planning control area declaration □ Interim development order Name of scheme/details of declaration or order, and number of any provision
contravened — | |||||
Modified penalty |
The modified penalty for the alleged offence is $ | |||||
Vehicle details 3 |
Plate No. | |
State | | ||
Licence expiry date | |
Vin/Chassis No. | | |||
Make | |
Colour | | |||
Body type | | |||||
Date of notice | | |||||
Service details [Tick one box] |
This notice was served — |
Date | | |||
Officer issuing notice |
Name | | ||||
Office | | |||||
Responsible authority | | |||||
Signature | | |||||
Notice to alleged offender |
It is alleged that you have committed the above offence. | |||||
Alleged offender’s response [Tick one box] |
To — 4
|
Notes to Form 1 —
1. The details should
say what the alleged offender has done that is a contravention of the law.
2.
Complete this if an offence against s. 218,
220 or 221 of the Act is alleged.
3. Include
vehicle details if alleged offence relates to a vehicle or to a person driving
a vehicle.
4. Insert the name and address of the
responsible authority and the officer responsible for dealing with
infringement notices.
2 . Withdrawal of infringement notice (r. 43(2))
Planning and Development Act 2005 s. 231 |
Withdrawal of infringement notice | ||||
Alleged offender |
Family name | | |||
Given names | | ||||
Address |
| ||||
Infringement notice |
Number | | |||
Date issued | | ||||
Description of alleged offence |
Date | |
Time | | |
Place | | ||||
Details | | ||||
Law contravened | |||||
Date of this notice | | ||||
Officer issuing this notice |
Name | | |||
Office | | ||||
Responsible authority | | ||||
Signature | | ||||
Notice to alleged offender |
The above infringement notice, which was issued for the above alleged offence,
has been withdrawn. If you have already paid the modified penalty in accordance with the
infringement notice, you are entitled to a refund of the money. To obtain a refund post this notice to — 1 |
Notes to Form 2 —
1. Insert the name
and address of the responsible authority and the officer responsible for
dealing with application for refunds.