Form 3Y INFORMATION AND SUMMONS WITH Court Use WRITTEN GUILTY PLEA Date Filed: Youth Court of South Australia Criminal Procedure Act 1921 Sections 49, 57 and 57A Highest Charge: Summary Minor Indictable Major Indictable Informant Name Street Telephone Facsimile Address City/Town/Suburb State Postcode Email Address Informant’s References Reference No: Instant Loss of Licence No: Defendant DOB Name dd/mm/yyyy Street Telephone Licence Number Address City/Town/Suburb State Postcode Email Address Offence details: Other orders sought: (forfeiture, compensation, additional penalty, destruction or the like Rule 15.03) – Date INFORMANT Registry Date Address Time am/pm Hearing details Telephone Facsimile Email Address Date MAGISTRATE / REGISTRAR / JUSTICE OF THE PEACE
Form 3Y INFORMATION AND SUMMONS WITH WRITTEN GUILTY PLEA Youth Court of South Australia Criminal Procedure Act 1921 Sections 49, 57 and 57A Court Use Date Filed: Highest Charge: Summary Minor Indictable Major Indictable Informant Name Address Street Telephone Facsimile City/Town/Suburb State Postcode Email Address Informant’s References Reference No: Instant Loss of Licence No: Defendant Name DOB dd/mm/yyyy Address Street Telephone Licence Number City/Town/Suburb State Postcode Email Address Offence details: Other orders sought: (forfeiture, compensation, additional penalty, destruction or the like – Rule 15.03) Date INFORMANT Hearing details Registry Date Address Time am/pm Telephone Facsimile Email Address Date MAGISTRATE / REGISTRAR / JUSTICE OF THE PEACE