ࡱ> q` bjbjqPqP h::, ffff$F1F1F1F1t1TX22444 5w8 ::xOWQWQWQWQWQWQW$Zhj\uWo;s8w8o;o;uWff4 5gX>>>o;f"4 5OW>o;OW>>PrSR42 4EF1;FQSl$X0TXQb];b]0SRSRb]gR|o;o;>o;o;o;o;o;uWuW> o;o;o;TXo;o;o;o;Dbbffffff PENALTY REMINDER NOTICEEnforcement Agency   FORMTEXT       INSERT NAME OF RESPONSIBLE AUTHORITY Infringements Act 2006 Penalty Reminder Notice Number:  FORMTEXT      Penalty Enquiries (  FORMTEXT      Date of Notice  FORMTEXT      / FORMTEXT      / FORMTEXT       Family name of person served with Infringement Notice (or company name) FORMTEXT      Given names of person FORMTEXT      Address of person or registered address of company FORMTEXT       FORMTEXT      State FORMTEXT      p/c FORMTEXT       Name of Issuing OfficerSignature of Issuing Officer FORMTEXT      Location of Issuing Officer  FORMTEXT       INFRINGEMENT PENALTY AND PRESCRIBED COSTS OWINGDUE DATE$  FORMTEXT       FORMTEXT      / FORMTEXT      / FORMTEXT      Approx. time of offenceAddress of the place where the infringement offence was committed FORMTEXT       FORMTEXT      Date of offence FORMTEXT       MANNER IN WHICH INFRINGEMENT PENALTY MAY BE PAIDNOTE: FAILURE TO PAY THE INFRINGEMENT PENALTY AND PRESCRIBED COSTS OWING BY THE SPECIFIED DUE DATE MAY RESULT IN FURTHER ENFORCEMENT ACTION BEING TAKEN AND THE FURTHER COSTS BEING INCURRED UNDER THE ACT.You must do one of the following by the due date: Pay in full by using one of the payment methods available or, if you are eligible, apply for a payment plan* and make the first payment within the time required under that plan; OR Have the matter dealt with in a Court or, in the case of a child, in the Childrens Court, by completing the Application for Action by a Court on the back of this Infringement Notice; OR You, or a person acting on your behalf, may apply to have the decision to serve this Infringement Notice internally reviewed.* *You may be eligible for a payment plan. Further information relating to eligibility for payment plans and applying for an internal review can by obtained by contacting  FORMTEXT       INSERT DETAILS OF CONTACT FOR INFORMATION ABOUT INTERNAL REVIEW AND PAYMENT PLANS.Additional information may be found at  FORMTEXT       INSERT RESPONSIBLE AUTHORITY S WEB PAGE ADDRESS IF INFORMATION IS AVAILABLE ON ITIf you do not understand this notice, you should seek advice from the registrar of the Court or Children's Court, as the case requires, a lawyer or Victoria Legal Aid.(In Person:  FORMTEXT       INSERT DETAILS OF WHERE PENALTY CAN BE PAID IN PERSON. FORMTEXT  ( Mail:  FORMTEXT       INSERT DETAILS OF WHERE PENALTY CAN BE PAID IN PERSON. This notice must accompany payment as unidentified payments cannot be processed. Please note: In line with common practice, a receipt will not be issued for payments received through the mail.  PENALTY REMINDER NOTICEEnforcement Agency   FORMTEXT       Infringements Act 2006 Penalty Reminder Notice Number:  FORMTEXT       IF YOU DON T PAY ON TIMEFailure to pay the infringement penalty and any prescribed costs by the specified due date may result in further enforcement action being taken and further costs being incurred under the Act. If the matter is referred to the Magistrates Court you are entitled to defend any such proceedings. The Issuing Officer may withdraw this notice within 28 days of it being issued. However, this happens only rarely. If it happens in this case, the Issuing Officer will write to you and your payment will be refunded. APPLICATION FOR ACTION BY A COURTI, _________________________________________________________________________________________________________________ (Full name) decline to be dealt with under the Infringement Notice Enforcement provisions, and want to have the matter dealt with by a court. I understand I may receive a summons for this offence. Signed:______________________________________________________________________________________________Address for the service of documents: ______________________________________________________________________________________________ __________________________________________________________________________ Postcode: ___________ APPLICATION TO HAVE THE INFRINGEMENT NOTICE INTERNALLY REVIEWED#I, _________________________________________________________________________________________________________________ (Full name) believe the decision to issue this Infringement Notice (strike through non-applicable): was contrary to law; OR involved a mistake of identity; OR that special circumstances^ apply in my case: OR my conduct for which the infringement notice was served should be excused having regard to my exceptional circumstances. I have enclosed an accompanying statement to support my application. 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Special circumstances also extend to the homeless, where homelessness results in the person being unable to control the offending conduct. If you have been served with more than one infringement notice, an application for internal review will need to be completed and submitted for each infringement notice that you wish to have reviewed. Only one application for internal review can be made regarding any one infringement offence. As part of the internal review process you may be asked for additional information and, if this occurs, you must provide that information within 14 days. The person conducting the internal review may decide, in all the circumstances, to: withdraw the infringement notice and refer the matter for prosecution in court; OR confirm the decision to issue the infringement notice; OR withdraw the infringement notice and serve an official warning in its place; OR withdraw the infringement notice; OR waive all or any prescribed costs; OR approve a payment plan; OR any combination of these actions. Further information and information relating to eligibility for payment plans and applying for internal review can be obtained by telephoning  FORMTEXT HxIxxEy {2|| }s}}}yyyyynWWW & F e($If^e`gd[ P$Ifgd0TE ($Ifgdzkd$$$IfTl40v .1 " 0*4 laf4T xxDy{{1|2|~~~ ! ,.0:<І҆ԆކƼtfb^h=1hHje'h?!hGUj&h?!hGU jh?!h[UmHnHuUjy&h?!hGUjh?!h[U h?!h[ h?!h vh?!hQ5CJh?!h0TECJaJh?!hE5CJaJh?!hECJaJh?!hE%CJaJh?!hE%CJH*aJ#}"~H~c~~~~>@idddddbgd gkd%$$IfTl4v.*   0*4 laf4T & F eP$If^e`gd[ & F e($If^e`gd[       on:  FORMTEXT       Send correspondence relating to this infringement notice to:  FORMTEXT       gd  2&P :p. A!7"7#8$% 2&P :p. 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