Magistrates Court Act 1930—Form 38

Conviction when the punishment is imprisonment, and costs are awarded to be levied by execution
Australian Capital Territory, 
                           to wit.	}	
BE it remembered that on the                              day of                        , 20   , 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 be imprisoned in the gaol at                              , in 
the                                   , for the space of                                            , and AB was also adjudged to pay to CD the sum of                   for [his or her] costs; and if the sum for costs is not paid forthwith [or on or before
                                         next] then it is hereby ordered that the sum 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