IN THE MATTER OF: THIS FORM IS FILED ON BEHALF OF: ADDRESS: THIS MATTER IS NEXT LISTED ON: [date] FOR . CONTACT DETAILS [If represented, please complete the legal practitioner details below] Contact No.: Email address: Address for service: *I have Legal Representation [complete below] *I do not have Legal Representation Firm: Practitioner's Name: Solicitor Code: Ref.: TO the Registrar of the County Court at: AND TO the Respondent: [name] of [address] *I wish to abandon my appeal against conviction and sentence in the Children's Court at [place] on [date] The Children's Court reference number is The *conviction/*sentence/*orders imposed were I acknowledge that the *conviction/*sentence/*order appealed will take effect immediately upon lodging this form. Date:
IN THE MATTER OF: THIS FORM IS FILED ON BEHALF OF: ADDRESS: THIS MATTER IS NEXT LISTED ON: [date] FOR . CONTACT DETAILS [If represented, please complete the legal practitioner details below] Contact No.: Email address: Address for service: *I have Legal Representation [complete below] *I do not have Legal Representation Firm: Practitioner's Name: Solicitor Code: Ref.: TO the Registrar of the County Court at: AND TO the Respondent: [name] of [address] *I wish to abandon my appeal against conviction and sentence in the Children's Court at [place] on [date] The Children's Court reference number is The *conviction/*sentence/*orders imposed were I acknowledge that the *conviction/*sentence/*order appealed will take effect immediately upon lodging this form. Date:
09-183sr003.docx