In the Magistrates' Court of at [venue] Court Reference: INSTALMENT VARIATION OF INSTALMENT ORDER APPLICATION [date] In [date] the case I against was ordered me by to [set pay a fine. on out details] I [full name] of [address and occupation] now apply to the proper officer of the Magistrates' Court at [venue] for— an order that time be allowed for payment of the fine an that the fine be paid by instalments an order for the variation of the terms of an instalment order. DETAILS OF THE COURT The Court ordered that I pay $ in fines and costs. I was was not present when the order was made. The Court ordered that the fines and costs be paid— by [date] by instalments of $ to be paid on the day of each week fortnight month. did not make any about payment. DETAILS OF PAYMENTS MADE BY ME [Set out details of payments made] FUTURE PAYMENTS
In the Magistrates' Court of at [venue] Court Reference: INSTALMENT VARIATION OF INSTALMENT ORDER APPLICATION [date] In the case against me by [set out details] on [date] I was ordered to pay a fine. I [full name] of [address and occupation] now apply to the proper officer of the Magistrates' Court at [venue] for— an order that time be allowed for payment of the fine an that the fine be paid by instalments an order for the variation of the terms of an instalment order. DETAILS OF THE COURT The Court ordered that I pay $ in fines and costs. I was was not present when the order was made. The Court ordered that the fines and costs be paid— by [date] by instalments of $ to be paid on the day of each week fortnight month. did not make any about payment. DETAILS OF PAYMENTS MADE BY ME [Set out details of payments made] FUTURE PAYMENTS
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