3090GOVERNMENT GAZETTE, WA 15 July 2021

3090 GOVERNMENT GAZETTE, WA 15 July 2021 registration: ................................................ , you committed the following offence— ......................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... The modified penalty for the offence is $ ............... If you do not wish to have a complaint of the alleged offence heard and determined by a court, the amount of the modified penalty may be paid to an authorised person at (5) ............................. within a period of 28 days after the giving of this notice. If you do not pay the modified penalty within 28 days after the date of this notice, 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 actions 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. If the above address is not your current address, or if you change your address, it is important that you advise us immediately. Failure to do so may result in your driver’s licence or any vehicle licence you hold being suspended without your knowledge. (6) ................................................................................................................................................................... (7) ................................................................................................................................................................... (1) Name of alleged offender or ‘the owner’ (2) Address of alleged offender (5) Place where modified penalty may be paid (6) Signature of authorised person (7) Name and title of authorised person giving notice ———— FORM 3 INFRINGEMENT NOTICE To: (1) ............................................................................................................................................................. of: (2)................................................................................................................................................................ It is alleged that on .......... / .......... / .......... at (3) .......................................................................................... at (4) ............................................................................................................................................................... registration: ................................................ , you committed the following offence— ......................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... The modified penalty for the offence is $ ...............