Yes/No Abridged by consent: Yes/No Accused in custody: Notice given to central prison records: Yes/No Signature of applicant: Date: __________________ 16 Form 16 Rule 29 In the Magistrates' Court of at [venue] Court Reference: This application is made by: the victim a person on behalf of the victim the prosecutor of the identity crime offence Name of Applicant: In the matter of: [Prosecuting and [Offender] Agency] I [name apply *on behalf of [name a victim of of applicant] of victim]*as identity crime, for a certificate under section 89F of the Sentencing Act 1991. [Accused] was found guilty of an identity crime offence under Division 2AA of Part I of the Crimes Act 1958 on [date of conviction]. Victim: Name: Date of birth:
Abridged by consent: Yes/No Accused in custody: Yes/No Notice given to central prison records: Yes/No Signature of applicant: Date: __________________ 16 Form 16 Rule 29 In the Magistrates' Court of at [venue] Court Reference: This application is made by: the victim a person on behalf of the victim the prosecutor of the identity crime offence Name of Applicant: In the matter of: [Prosecuting Agency] and [Offender] I [name of applicant] apply *on behalf of [name of victim]*as a victim of identity crime, for a certificate under section 89F of the Sentencing Act 1991. [Accused] was found guilty of an identity crime offence under Division 2AA of Part I of the Crimes Act 1958 on [date of conviction]. Victim: Name: Date of birth:
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