Section 960 - The following parts of the Town of Kwinana Health By–Law 1963 - GOVERNMENT GAZETTE, W.A. [28 February, 1964.

960 GOVERNMENT GAZETTE, W.A. [28 February, 1964. P 70 (a) APPLICATION FOR AN "ADDITION" TO A DRIVER'S LICENSE NAME IN FULL (Block letters) ADDRESS hereby apply for an addition of a to my M D L No CONDITION OF EYESIGHT (Without (With glasses) glasses) R. Eye el . R. Eye 61 ..... ....... L. Eye 61 L. Eye 61 ........ Both eyes 61 of certify that the particulars contained in this application are true and correct and that I suffer from no physical disability which would affect my efficiency in controlling a Date of application Signature I have tested this applicant and certify that he is capable of driving a ADDED to D.L. No. Station Date Signature

28 February, 1964.] GOVERNMENT GAZETTE, W.A. 961 TRAFFIC ACT, 1919 P. 705. APPLICATION FOR. AN 'EXTRAORDINARY LICENSE TO DRIVE A MOTOR VEHICLE I hereby apply for. an Extraordinary License to drive a Motor mncl I furnish the NO. QUESTIONS ANSWERS OP APPLICANT

What is .your full name? (state Mr., Mrs., or Miss) .... SURNAME CHRISTIAN NAMES (Full name to be in Block Letters)
What is your permanent residence? (in full) ....
What is your temporary residence?
What Is your occupation? ....
Where were you born? .... ....
What is your date of birth?....
What is your description? ,... Height feet inches
Have you previously held a Driver's License? If so when wat it first issued and where? ,...
Have you ever applied for and been refused a License . _ 10: Have you ever been disqualified from holding or obtain- ing a License anywhere? .... .... ...
Has your Driver's License ever been cancelled or sus- pendedanywhere? .... ,.... .... .... ....
Have you been convicted by ANY COURT of ANY OFFENCE? If so, give full particulars ....
Is your eye sight defective? If so, give particulars? ....
Is your hearing defective? If so, give particulars .... So, give particulars .... • .... .... .... ....
Do you suffer from epilepsy or fits?
Do you suffer from diabetes? .... ....
Are you receiving insulin treatment? .... .... „..

960GOVERNMENT GAZETTE, W.A. [28 February, 1964.

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