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Picture: Local Government Elections

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= Required Fields

Online Form - Have the Matter Dealt With by Court

Declaration by you

I, named below, wish to have this matter dealt with by a Court and understand that I will be receiving a summons in due course.

Personal Details

Please complete all details in full

Title

Given Names *

Surname *

Infringement number *

Vehicle registration number *

Residential address for the service of the Summons (PO Box not accepted) *

Suburb *

State

Postcode

Phone number

Mobile

Email Address

Reason for contesting infringement:

Type the code from the image