Under what law? State Act Regulation No. (Full Ref.) Commonwealth Regulation Other— specify Are there more charges? No Yes—see 2 Type of offence Summary offence Indictable offence Request for committal proceeding No Yes 2. What is the charge? (Description of offence) Act or Section or Clause Under what law? State Act Regulation No. (Full Ref.) Commonwealth Regulation Other— specify Are there more charges? No Yes—see "Continuation of Charges" attached Type of offence Summary offence Indictable offence
Charge Number Date of Offence S C G NG XP Brief of offence Act and Section (Detention) Term Portion of term to be served (where app.) Sentence (Period) Code Min. Term C'wlth only There are more pages No Yes — pages Registrar Warrant Execution Details Form 22 Police Station Warrant executed by me on at a.m./p.m. Name Rank and Number __________________ 23 Form 23 Rule 36 Ref. Offender's Name: M F Address: Who filed the charges? Agency: DETAILS OF THE FINE
__________________ 30 Form 30 Rule 46 (Section 110 of the Criminal Procedure Act 2009) In the Magistrates' of at [venue] Court Reference: 1. A Notice of Committal Mention Date and Hand-up Brief and a copy of the charge-sheet relating to the alleged offence. 2. A statement of the material facts relevant to the charge is attached. *3. were made for the examination of [names of persons] under section 104 of the Criminal Procedure Act 2009 and transcript(s) of the examination(s) *is/are *attached/*not attached. OR *3. No orders were made for the examination of any person under section 104 of the Criminal Procedure Act 2009. OR *3. There are no forensic procedures, examinations or tests on which the prosecutor intends to rely as tending to establish the guilt of the accused that are not yet completed. OR *3. The following forensic procedures, examinations or tests on which the prosecutor intends to rely as tending to establish the guilt of the accused are not yet completed [describe here any forensic procedures, examinations or tests that are not yet completed].
In the Magistrates' Court of at [venue] Court Reference: INSTALMENT VARIATION OF INSTALMENT ORDER APPLICATION [date] In the case against me by [set out details] on [date] I was ordered to pay a fine. I [full name] of [address and occupation] now apply to the proper officer of the Magistrates' Court at [venue] for— an order that time be allowed for payment of the fine an that the fine be paid by instalments an order for the variation of the terms of an instalment order. DETAILS OF THE COURT The Court ordered that I pay $ in fines and costs. I was was not present when the order was made. The Court ordered that the fines and costs be paid— by [date] by instalments of $ to be paid on the day of each week fortnight month. did not make any about payment. DETAILS OF PAYMENTS MADE BY ME [Set out details of payments made] FUTURE PAYMENTS
I now want to pay the money I owe by / / by instalments of $ on the day of each week fortnight month starting on [date]. DETAILS OF MY INCOME AND EXPENSES At present I receive $ each week after tax has been deducted. My weekly expenses are $ This leaves me with $ [To be completed by the proper officer] I received this application on [date]. [Signature] name] Form 47 NOTE: The registrar who deals with this application will notify you in writing of the decision. Tick whichever applies __________________ 48 Form 48 Rule 98 (Section 55(1) of the Sentencing Act 1991) In the Magistrates' Court of at [venue] Court Reference: