Form 104 WARRANT Court Use Magistrates Court of South Australia Date Filed: Correctional Services Act 1982 Sections 76 or 76A Application made: personally by telephone by facsimile Registry File No Street Telephone Facsimile DX Address City/Town/Suburb State Postcode Email Address Applicant Name Surname Given name/s Street Telephone Facsimile Address City/Town/Suburb State Postcode Email Address Parolee Name DOB Surname Given name/s dd/mm/yyyy Street Address City/Town/Suburb State Postcode Terms of the Warrant I, the undersigned Magistrate, authorise: the arrest of the parolee; or the arrest and return to prison of the parolee Date MAGISTRATE
Form 104 WARRANT Magistrates Court of South Australia Correctional Services Act 1982 Sections 76 or 76A Court Use Date Filed: Application made: personally by telephone by facsimile Registry File No Address Street Telephone Facsimile DX City/Town/Suburb State Postcode Email Address Applicant Name Surname Given name/s Address Street Telephone Facsimile City/Town/Suburb State Postcode Email Address Parolee Name DOB Surname Given name/s dd/mm/yyyy Address Street City/Town/Suburb State Postcode Terms of the Warrant I, the undersigned Magistrate, authorise: the arrest of the parolee; or the arrest and return to prison of the parolee Date MAGISTRATE
Form%20104%20-%20Warrant.docx