Page No. Person charged: (Description of offence) Act or Section or Clause State Act Regulation No. (Full Ref.) Commonwealth Regulation Other—specify Summary offence Indictable offence Request for No Yes committal proceeding (Description of offence) Act or Section or Clause State Act Regulation No. (Full Ref.) Commonwealth Regulation Summary offence Indictable offence Request for No Yes committal proceeding Is this an Yes No—See infringement offence? Enforcement Enforcement review review—special circumstances Infringements Other—specify Act 2006 section 40 Are there more charge(s)? No Yes—see page No. Signature of Informant:
Page No. Person charged: (Description of offence) Act or Section or Clause State Act Regulation No. (Full Ref.) Commonwealth Regulation Other—specify Summary offence Indictable offence Request for committal proceeding No Yes (Description of offence) Act or Section or Clause State Act Regulation No. (Full Ref.) Commonwealth Regulation Summary offence Indictable offence Request for committal proceeding No Yes Is this an infringement offence? Yes No—See Enforcement review Enforcement review—special circumstances Infringements Act 2006 section 40 Other—specify Are there more charge(s)? No Yes—see page No. Signature of Informant:
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