Conservation and Land Management Act 1984Conservation and Land Management Regulations 2002Forest Management Regulations 1993INFRINGEMENT NOTICE Infringement
notice no.
Alleged offender(not required if notice served under s. 114B or 114D) Family name
Given names
Company/
business trading as
ACN/ABN
(if applicable)
Address
The responsible person for vehicle or owner of vessel in relation to which offence occurred
Vehicle/vessel registration no.
Details of alleged offence Date: / /20 Time: am/pm
PlaceNearLocality/tenure
Act/regulation contravened: Section/
regulation:
Details of offence:
Date Date of notice: Time of notice:
Issuing officer Surname: Number:
Signature:
Modified penalty $_____
TAKE NOTICE It is alleged that you have committed the above offence/that you are the responsible person for the vehicle/vessel in relation to which the above offence occurred.If you do not want to be prosecuted in court for the offence, the modified penalty must be paid to the CEO within 28 days after the date of this notice.If the modified penalty is not paid within 28 days, you may be prosecuted or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994. Under that Act, some or all of the following action may be taken:your driver’s licence may be suspended, your vehicle licence may be suspended or cancelled, you may be disqualified from holding or obtaining a driver’s licence or vehicle licence, your vehicle may be immobilised or have its number plates removed, your details may be published on a website, your earnings or bank accounts may be garnished, and your property may be seized and sold.Paying the modified penalty will not be regarded as an admission for the purposes of any civil or criminal court case.
**If you want this matter to be dealt with by prosecution in court:**Lodge a request online using the form provided at www.dpaw.wa.gov.auORSign and date here: __________________________________ / /20
and post this notice to the CEO at the address below.
If you consider that you have good reason to have this notice withdrawn, you can write to the CEO at the address below requesting that this notice be withdrawn and setting out why you consider that this notice should be withdrawn. Your letter must be received not later than 28 days after the date of this notice.
Schedule Sch 3 - Conservation and Land Management Regulations 2002 - Forms | Zoe
If infringement notice served on responsible person for a vehicle or owner of a vessel As the responsible person/owner you will be presumed to have been the driver or person in charge of the vehicle/vessel unless within 28 days after the date of this notice:(a) the modified penalty is paid; or(b) you supply the CEO with the following information:the name and address of the driver or person in charge of the vehicle/vessel at the time of the alleged offenceorinformation showing that at the time of the alleged offence the vehicle/vessel had been stolen or unlawfully taken or was being unlawfully used.For further information see the Conservation and Land Management Act 1984 sections 114A‑114E (www.legislation.wa.gov.au).
How to pay****Note: for payment in person you MUST ensure that you provide your INFRINGEMENT NOTICE NUMBER By post Tick the relevant box below and post payment to:Chief Executive Officer
Department of Biodiversity, Conservation and Attractions
Locked Bag 104
Bentley DCBentley WA 6983. A cheque or money order (payable to ‘Chief Executive Officer, Department of Biodiversity, Conservation and Attractions’) for the modified penalty is enclosed.
In person Pay the cashier at any office of the Department of Biodiversity, Conservation and Attractions, or pay over the telephone by credit card by calling the general telephone number of any office of the Department of Biodiversity, Conservation and Attractions.
[Form 1 inserted: Gazette 11 Dec 2015 p. 4954‑6; amended: Gazette 14 Sep 2018 p. 3308; SL 2020/166 r. 6.]
To ............................................................................................................... (name) of ............................................................................................................................ ................................................................................................................. (address)
Infringement Notice No. .......................... Date ......./......./....... for the alleged offence of .............................................................................................................. ......................................................................................................................... and specifying the modified penalty of $........................ is withdrawn.
No further action will be taken against you. *
OR
It is proposed to commence court proceedings against you for the alleged offence. *