This order was made on [date] at [venue]. [*Signature of magistrate/*proper officer] *Delete if not applicable __________________ Form 53 amended by S.R. No. 24/2014 rule 24. 53 Rule 103 (Section 69M(1) of the Sentencing Act 1991) In the Magistrates' Court of at [venue] Court Reference: Date of birth Informant of TO: 1. On [date] you were found guilty of an offence and the Court ordered you to pay the following amount(s): Charge Statutory Costs/Other No. Act/section Fine Costs amount(s) Paid Unpaid $ $ $ $ $ TOTAL AMOUNT NOW PAYABLE
This order was made on [date] at [venue]. [*Signature of magistrate/*proper officer] *Delete if not applicable __________________ Form 53 amended by S.R. No. 24/2014 rule 24. 53 Rule 103 (Section 69M(1) of the Sentencing Act 1991) In the Magistrates' Court of at [venue] Court Reference: Date of birth Informant of TO: 1. On [date] you were found guilty of an offence and the Court ordered you to pay the following amount(s): Charge No. Act/section Fine $ Statutory Costs $ Costs/Other amount(s) $ Paid $ Unpaid $ TOTAL AMOUNT NOW PAYABLE
09-181sr012.docx