Transcription of APPLICATION FOR A COURT HEARING - courts.justice.wa.gov.au
1 To view your outstanding fines, infringements or your existing payment arrangement, you can do so at: To view your outstanding fines, infringements or your existing payment arrangement, you can do so at: Government of Western Australia Department of JusticeFines Enforcement Registry APPLICATION FOR A COURT HEARING To: The Registrar FAX: (08) 9425 7070 Fines Enforcement Registry GPO Box X2293 EMAIL: PERTH WA 6847 I hereby elect for the following cases to be dealt with by a Magistrates COURT pursuant to Section 21(4) of the Fines, Penalties and Infringement Notices Enforcement Act 1994.
2 Applicant Details Full Name: Address: (must be a residential address and not a PO BOX address) Telephone Number: (H) (Mob) Email: Date of Birth: / / MDL Number Reason for APPLICATION (must be completed) Case Number/s Alleged Offence/s Agency who issued Infringement Example: WA Police, City of Subiaco I understand that I will receive a summons and be required to attend COURT in due course. Date Applicant s signature Registry use only Date Received Signed
