[On or around [ date ], an [ give detail of tree/trees ] situated in the [ title of conservation area ] was removed in contravention of section xxx of the Act.
[Ar neu o gwmpas [dyddiad ], cafodd [ rhowch fanylion y goeden/coed ] a leolir yn [ teitl yr ardal gadwraeth ] [ei] [eu] gwaredu, yn groes i adran xxx o'r Ddeddf.