Form 17 NOTICE OF PREVIOUS CONVICTIONS Court Use Magistrates Court of South Australia Date Filed: Summary Procedure Act 1921 Section 62D Registry File No Street Telephone Facsimile Address City/Town/Suburb State Postcode Email Address Person charged Name Reference Surname Given name/s Street Telephone Address City/Town/Suburb State Postcode Email Address Charges against you: If you are convicted of these offences, the following previous convictions will be alleged against you: You should attend Court or have a solicitor attend for you. If you fail to attend: the matter may be dealt with without you, or • a warrant may be issued for your arrest. • Person or agency alleging previous convictions DOB Name Surname Given name/s dd/mm/yyyy Street Telephone Facsimile Address City/Town/Suburb State Postcode Email Address Registry Date Next hearing Address Time am/pm Telephone Facsimile Email Address Date
Form 17 NOTICE OF PREVIOUS CONVICTIONS Magistrates Court of South Australia Summary Procedure Act 1921 Section 62D Court Use Date Filed: Registry File No Address Street Telephone Facsimile City/Town/Suburb State Postcode Email Address Person charged Name Reference Surname Given name/s Address Street Telephone City/Town/Suburb State Postcode Email Address Charges against you: If you are convicted of these offences, the following previous convictions will be alleged against you: You should attend Court or have a solicitor attend for you. If you fail to attend: • the matter may be dealt with without you, or • a warrant may be issued for your arrest. Person or agency alleging previous convictions Name DOB Surname Given name/s dd/mm/yyyy Address Street Telephone Facsimile City/Town/Suburb State Postcode Email Address Next hearing Registry Date Address Time am/pm Telephone Facsimile Email Address Date
Form%2017%20-%20Notice%20of%20Previous%20Convictions.docx