Magistrates Court Act 1930—Form 36

Conviction for a penalty to be levied by execution
Australian Capital Territory, 
                           to wit.	}	
BE it remembered that on the                           day of                          , 20    , at Canberra, in the Territory, AB of                                    , in the 
Territory [                                            ], is convicted before the Magistrates Court at Canberra, that  AB [etc stating the offence and the time and place when and where it was committed], and AB was adjudged for [his or her] offence to forfeit and pay the sum of                              [stating the penalty and the compensation, if any] to be paid and applied according to law, and also to pay to CD the sum of                                  for [his or her] costs, and if the several sums are not paid forthwith [or on or 
before                                      next] then it is hereby ordered that the sums be levied by execution against the goods and chattels of AB
Given under my hand, at Canberra, in the Territory, the day and year first abovementioned.
	[Signature]
	Magistrate

Endnotes
1	This form was originally in the Magistrates Court Act 1930 (the authorising Act), schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the authorising Act and became a form approved under section 256 of that Act (see amdts 1.2764 and 1.2769).
2	Under the Court Procedures Act 2004 A2004-58, pt 8, this form became a form approved under that Act.
3	This republication includes amendments made under the Legislation Act, part 11.3 (Editorial changes).

©  Australian Capital Territory 2005