History Details
Casino Control Regulations 1999
5 February 1999 - 29 January 2004

Schedule 1 ¾ Prescribed forms
[r. 19]
Form 1

Western Australia

Casino Control Act 1984, s. 29I

INFRINGEMENT NOTICE


No: . . . . . . . . . . .
Date of Service: . . . . . . . . . . . . . .
1.To: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(surname) (other names)

of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode . . . . . .

It is alleged that at about . . . . . . . . . . . a.m./p.m. on the . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . , at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(name of premises)

you committed the offence described below and are liable for the modified penalty stated.

. . . . . . . . . . . . . . . . . . . . . . . . . .
*Police officer or
Authorized officer for the
Gaming Commission
of Western Australia

2.
Section
Description of offence
Modified penalty
3.If for any reason you wish to have the matter determined in a court hearing you need not reply and may decline to pay the modified penalty, but in that case court proceedings may be taken against you and you may be liable both for costs and a fine for the offence.

4.You may pay the modified penalty within 28 days of the date of this notice, but if the modified penalty is not then paid you will be deemed to have declined to pay it and court proceedings may be taken.

5.Payment may be made by completing item 6 and either ¾

(a) posting this form and a cheque, money order or postal note for the amount of the modified penalty specified in item 2, to the Gaming Commission, P.O. Box 6119, East Perth, W.A. 6892; or

(b) delivering this form and paying the amount to the Gaming Commission, 1st Floor, Hyatt Centre, 87 Adelaide Terrace, Perth, W.A. 6000.


6.I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(name)

of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(number and street)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(town or suburb) (postcode)

agree to pay the modified penalty for the offence indicated in this form.


. . . . . . . . . . . . . . . . . . . .
(Signature of offender)

* Delete whichever is inapplicable


Form 2

Western Australia

Casino Control Act 1984, s. 29K

WITHDRAWAL OF INFRINGEMENT NOTICE


No: . . . . . . . . . . .
Date of Service: . . . . . . . . . . . . . .
To: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(name)

of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(address)

Infringement notice No.: . . . . . . . . . served on you on the . . . . . . . day of
. . . . . . . . . . . . . . . . . . , for the offence described below is hereby withdrawn.

. . . . . . . . . . . . . . . . . . . . . . . . . .
Authorized officer for the
Gaming Commission
of Western Australia

Section
Description of offence
Modified penalty



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Casino Control Regulations 1999 - Schedule.pdf