Document ID: chunk:federal_register_of_legislation:F2018N00133:schedule:3
Version: federal_register_of_legislation:F2018N00133
Segment Type: schedule
Provision Reference: sch 3
Character Range: 60571–62853

Schedule 3
LOCAL GOVERNMENT ACT (CI)1995
FORM 4
PARKING AND PARKING FACILITIES LOCAL LAW 2017
WITHDRAWAL OF INFRINGEMENT NOTICE

Serial No ...............................
Date .......... / .......... / ..........
To: (1) ........................................................................................................................................................... of:
(2) ...........................................................................................................................................................
Infringement Notice No. ............................................................... dated .......... / .......... / ..........
in respect of vehicle:
make: .......................................................................;
model: ......................................................................;
registration: ..............................................................,
for the alleged offence of ............................................................................................................................. ....................................................................................................................................................................... ....................................................................................................................................................................... .......................................................................................................................................................................
has been withdrawn.
The modified penalty of $ ......................................
• has been paid and a refund is enclosed.
• has not been paid and should not be paid.
• delete as appropriate.
(3) ..........................................................................
(4) .................................................................................................................................................................
Insert:
(1) Name of alleged offender to whom infringement notice was given or 'the owner'.
(2) Address of alleged offender.
(3) Signature of authorised person
(4) Name and title of authorised person giving notice.

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