Infringement Review Request

Required fields are marked with an asterisk (*).

Personal Details

First Name *

Last Name *

Date Of Birth *

Telephone Number *

Email Address

Address

Unit / Street Number *

Street Name *

Suburb *

State / Territory *

Postcode *

Details Of Infringement

Infringement Notice Number *

Issue Date *

Reason For Your Request

There are limited circumstances where we will consider reducing or withdrawing an infringement. Select an option that applies to your situation. *

I did not commit the offence/s
Exceptional circumstances (outside of your control) resulted in the offence/s
The Infringement Notice was issued to the incorrect person
Other

Please give a full explanation of why you believe your fine should be reduced or withdrawn * 2000 Character Max or say refer to letter and upload attachment in next section

Supporting Documentation

Letter or Request If cannot fit in previous section or wish to upload a document

You may want to include any documentation that supports your request Photos, Proof of registration, witness statements etc

Proof Of ID

Please upload a valid identity document so we can verify your identity * Accepted ID documents can be a Drivers License, Proof of Age Card, Passport or Australian Defence Force ID. Please Note: That the ID uploaded must match the name on the Infringement Notice.

Declaration

I agree that: *

the information I have provided is true, accurate and correct.

I agree that: *

by typing my name below, I have signed this form.

Name Of Signatory *

Personal Information Protection Statement

The personal information that Council collects from you is deemed personal information for the purposes of the Personal Information Protection Act 2004. The intended recipients of personal information collected by Latrobe Council may be:

* Officers within Latrobe Council

* Data service providers engaged by Council from time to time

The supply of the information by you is voluntary. If you cannot provide or do not wish to provide the information sought, Latrobe Council may be unable to process your application or request. Council is collecting this personal information from you for the purposes of managing, assessing, advising upon and determining the relevant application. You may make an application to access or to amend your personal information held by Council. Please direct any enquiries regarding your personal information in writing to: General Manager, Latrobe Council, PO Box 63, Latrobe, TAS 7307.

Infringement Review Request

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