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					Bail Forms for JPs
                   Form 1

This document must be handed to any
person arrested, it sets out the rights of
the person detained.




                                    Page 3




      Page 2
                                           INFORMATION GIVEN BY ACCUSED




                                                                                                                                                                           Form 2
                                                         Bail Act 1982 Section 8(1)(b)

                                                                      Form 2.
Note for accused:            If you have difficulty with reading, speaking or writing English you must be given the help
                             necessary to understand and complete this form.

1. Accused details           Full Name
                                                           JONES Paul John Stephen
                             Address                       5 Smith Street Duncraig                            Date of Birth           12 July 1944

                             Tick [] appropriate box                                                         Telephone No.           08 9246 1234
                             Email Address
                             Fax No.
2. Charge(s)/                Fraud x 3
Appeal (s)/
Proceeding
(Insert brief particulars)


3. Court Ref No/s            PE 2163-5/02


   (a) I HAVE RECEIVED A COPY OF FORM 1 (INFORMATION FOR ACCUSED)                                                 Yes  No

   (b) I DO NOT WISH TO COMPLETE ANY PART OF THIS FORM (Delete if not applicable)

   Signature of accused: ________________________________________________ Date: ______/______/ 20______


NOTES FOR ACCUSED:
If you do not wish to answer any particular question on this form you should write "decline" next to it.
If you knowingly or recklessly give false information in connection with bail you are liable to a fine of up to $1,000 or imprisonment for
up to 12 months, or both.

4. Particulars of            Date of birth……12./07../…1944.
accused                      Nationality           Australian            Holder of          NIL                   passport
                                                                                                (country)
                             (or application for passport made to               N/A            but passport not yet received)
                                                                         (name of office)

5. Address                   No:               5               Street:                                       Smith Street
                             Suburb:               DUNCRAIG                    Postcode:    6023              Telephone No:    9246 1234

                             2.    Description of present address Tick [] appropriate box

                                       Own House                                                          Foster Home
                                       Parent's House                                                     Rented Accommodation
                                       Boarding House                                                     Hostel
                                       Other (describe) _____________________________


                             For child, address of parent(s): No:                           Street:

                             Suburb:                                                        Postcode:              Telephone No:


                             Intended address if granted bail (if different to above): No:                    Street:

                             Suburb:                                                        Postcode:              Telephone No:

                             Description of bail address (if different from above address) Tick [] appropriate box                                  Complete if a child
                                       Own House                                                      Foster Home
                                       Parent's House                                                 Rented Accommodation
                                       Boarding House                                                 Hostel
                                       Other (describe) ____________________________

                             During the past 5 years, how long have you been resident in Western Australia?             5    years.


                             For a child at school, name of school:   Complete if a child
6. Family       Marital status Tick [] appropriate box
Circumstances         Single                                                                De facto relationship




                                                                                                                                                Form 2
                      Married                                                               Divorced
                      Separated

                Dependants
                      (a) Children, number           4                (b)   Others, number: 1

                    (c) Relationship of those in (b) to you: Father              (d)    Children living with you, number: 0

                Nearest relative (including a de facto partner) Name: James JONES                               Relationship: FATHER

                Address: No:              5              Street:            Smith Street

                Suburb:                 DUNCRAIG                        Postcode:      6023            Telephone No:     9246 1234

7. Employment   Present occupation:            Financial Planner                                     Present employer:         Self

                Business address: No:          5      Street:       Smith Street           Suburb:       Duncraig         Post Code: 6023

                Period employed: 10 years

                Employment during the last 5 years:
                Employer                                           Business address                                           Period employed
                ______________________________ _____________________________________________                                  _____________
                ______________________________ _____________________________________________                                  _____________
                ______________________________ _____________________________________________                                  _____________
                ______________________________ _____________________________________________                                  _____________

                If refused bail would present employment be lost? Tick [] appropriate box
                                         Yes                                No                   Not Known

                Have you any intention of leaving your present employment? Tick [] appropriate box
                                         Yes                                No

8. Financial    Weekly income           (i) wages or salary after tax        $ 1250
position                                (ii) other income (state source) $ Nil

                Main assets (house, contents, land, motor car, bank account etc)
                Asset      House Contents                                                  Approx. value $ 45,000
                Asset      Car                                                             Approx. value $ 30,000
                Asset      Bank Account                                                    Approx. value $ 24,000
                Asset      _____________________________________________ Approx. value $ __________________________

                Main debts (mortgages, hire purchase, credit cards, fines etc)
                To whom owed                                                                       Approx. amount
                     Credit Card                                                                  $ 8,000
                     Hire Purchase                                                                $ 6,500
                __________________________________________________                                $___________________________________
                __________________________________________________                                $___________________________________


                Any other financial commitments? (show details)
                _____________________________________________________________________________________________
                __Child support $ 1,000 per month_____________________________________________________________
                _____________________________________________________________________________________________

                Are you on bail in another case?                                                   Yes                         No
                If yes, give details:
9. Background   _____________________________________________________________________________________________
                _____________________________________________________________________________________________

                Have you ever failed to answer bail ?                                              Yes                         No
                If yes, give details:


                Have you any previous convictions?                                                 Yes                         No
                If yes, give details:
                DUI 1983
                _____________________________________________________________________________________________
                _____________________________________________________________________________________________
10. Background
(continued)
                     Are you on probation or parole?
                     If yes, give details:
                                                                                                Yes

                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                                                                                                                              No

                                                                                                                                                    Form 2
                     Are there any proceedings against you pending in a civil court?            Yes                          No
                     If yes, give details:

                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________


11. Possible         Name                           Address                                         Phone No.                Relationship
sureties             Janice Brown                 112 Monmouth Street Morningside                  (07) 3899 1044            Sister

                     Paul Jones                   4 Pier Street PERTH                              9264 1122                 Brother
                     _____________________ ____________________________________ ____________________ ____________


12. Special          Outline special factors to be taken into account
                     (e.g. illness, physical impairment, employment, domestic difficulties etc):
reasons for
wanting bail:        I care for my father who is incapacitated
                     My business would be adversely affected
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________



THE ABOVE PARTICULARS ARE TRUE AND CORRECT
Signature of accused:_________________________________________________________ Date: _____/______/ 20_______



13. REVISION OF      REVISION OF ABOVE PARTICULARS [See section 8(2) and (4) of Act]
ABOVE
PARTICULARS          1st revision:
                     No change/revised as follows:
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________



                     Signature: _______________________________________________ Date: ______/______/ 20______
                                                                                                                                            This review can only be done
                     Judicial Officer/ Authorised Officer: __________________________
                                                                                                                                            by the original Justice of the
                                                                                                                                            Peace, unless the information
                     2nd and subsequent revisions:
                     (Judicial Officer or Authorised Officer to record position as per the preceding section, adding a new page if          originally   provided      was
                                                                                                                                            inaccurate or not complete.
                     necessary)
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________
                     _____________________________________________________________________________________________


                     Signature: _______________________________________________ Date: ______/______/ 20______

                     Judicial Officer/Authorised Officer:__________________________
                    NOTICE TO APPEAR WHERE BAIL DISPENSED WITH BY COURT
                                                BAIL Act 1982 Section 13A(3) and 13B
                                                            Form 4
                                                                                                                                             Form 4
1. Accused details           Full Name

                             Address                                                          Date of Birth

                             Tick [] appropriate box                                         Telephone No.
                             Email Address
                             Fax No.

You are required to appear at ________________________________________________________________________
on ____________ day the _________ day of ______________________ 20________,at _____________am/pm


2. Charge(s)/
Appeal (s)/
Proceeding                                                                                                                                     Prosecution copy
(Insert brief particulars)

3. Court Ref No/s




1.   Bail for that appearance is dispensed with.
2.    You may be brought back before the court (even though bail has been dispensed with) if there is sound reason to believe
      that you will not appear at the designated time and place for your next appearance in court. This could involve you being
      arrested by a police officer.
3.   You must, in writing, notify the court at which you are to appear of any change of residential address. It is an offence not to
     do so, without reasonable cause. The maximum penalty for the offence is a fine of $1000.


Signature of Court Registrar/authorised                                                         Date:
person:

                                                                                                                                                     Court copy

Note:       Your non-appearance at the abovementioned time, date and place could result in a warrant being
            issued for your arrest to bring you before the court for the matter/s to be dealt with, or the
            matters could be dealt with in your absence.
                                                                                                                                       Pages 2 & 3 of Form 4 are the
                                                                                                                                       same as page 1, except they
                                                                                                                   Accused copy        have an area to be completed
                                                                                                                                       after it has been served on the
                                                                                                                                       defendant.
                                                 BAIL RECORD FORM
                                                 BAIL Act 1982 Section 26(4)(b

                                                            Form 5
1. Accused
Details
                         Full Name

                         Address

                         Email Address /Fax
                         No.
                                                       SMITH Michael John

                                                       2 Prospect Road ARMADALE

                                                       michaelsmith@hotmail.com.au
                                                                                                 Date of Birth

                                                                                                 Telephone
                                                                                                 No.
                                                                                                                     17 May 1972


                                                                                                                    08 9288 4215
                                                                                                                                        REFUSED
                                                                                                                                                        Form 5
                         (Insert brief particulars)
2. Charge(s)/
Appeal (s)/
Proceeding
                         Steal M/V, Excess 0.08, No MDL
                                                                                                                                       Always request a copy of
                                                                                                                                       the defendants record
3. Court
Number/s                 25126-9/09
4. Date of               Court Date:        Perth                                             Time:        10          am/pm
appearance for
which bail               Court Location: 501 Hay Street PERTH
considered:

                                                  BAIL REFUSED - GENERAL
Tick [] appropriate box
5. ADULT                                                     CHILD
Bail is refused. There is no condition which I could          Bail is refused. There is no condition which I could
reasonably impose which would overcome the ground(s)          reasonably impose which would overcome the ground(s)
which influenced my decision to refuse bail. In exercising    which negate(s) any right of the accused to be released on
my discretion I have had regard to:                           bail. I considered that a right to be released on bail is
                                                              negated by the following factor(s):

1.        If the accused is not kept in custody he/she may:                                                     Tick [] appropriate
                                                                                                                box
          (a) fail to appear in court in accordance with his/her bail undertaking;                              
          (b) commit an offence;                                                                                
          (c) endanger the safety, welfare or property of a person;                                             
          (d) interfere with witnesses or otherwise obstruct the course of justice.
2.        The need of the accused to be held in custody for his/her own protection.
3.        The grounds for opposing the grant of bail put forward by the prosecutor namely:                      
          Likelyhood of reoffending
4.        The possibility that if the accused is not kept in custody the proper conduct of the trial may
          be prejudiced
5.        Any other ground
          (specify)

Reasons why above ground(s) apply (mention also any relevant factor referred to in the note below)

                  20 March 2009                                     Signature
Date
                                                                                              Authorised Officer/Justice/ or
                                                                                               Official Designation (title)

Note:         In considering (1) above regard shall be had to the following factors:
(a)           the nature and seriousness of the offence(s) including any other offence for which the accused is awaiting trial
              and the probable method of dealing with the accused for it/them if convicted;
(b)           The accused’s character, previous convictions, antecedents, associations, home environment, background,
              place of residence and financial position;
(c)           The history of previous grant(s) of bail to the accused;
(d)           The strength of evidence against him/her
                                             BAIL REFUSED – PARTICULAR GROUNDS
Tick [] appropriate box
        Bail is refused because -
         (a)        the accused is charged with a serious offence (as defined) committed while –
                    (i) on bail awaiting trial for a serious offence; or                                                               Notify the defendant of
                                                                                                                                       your decision
                         (ii) at liberty under an early release order in respect of another serious offence; and
                         (iii) charged with breaching a violence restraining order.
         (b)        there are no exceptional reasons why the accused should not be kept in custody; and.

         Bail is refused because -
         (a)        the accused is a child; and
         (b)        no responsible person is willing to enter into an undertaking required by clause 2(3)(c) of Part C of Schedule
                    1 ; and
         (c)        the accused is not –
                    (i) over 17; or
                    (ii) of sufficient maturity to live independently without the guidance or control of a parent or guardian
Note
1.
         Section 6 need only be completed -

         (a)
                                                     BAIL GRANTED


                 if bail is granted for an initial appearance in court after an authorized officer has previously refused bail for that
                                                                                                                                          Form 5
                 appearance; or
         (b)     if it appears to the bail decision maker that the accused is dissatisfied with any condition imposed (not including a
                 condition under clause 2(3)(c) of Part C of Schedule 1 to the Act).
Note     In the case of a child it is mandatory for consideration to be given to the conditions referred to in clause 2(1a) of Part D
2.       of Schedule 1 to the Act.

Tick [] appropriate box
* Appropriate amendments to be made if the discretion in Clause 2(4) of Part C of Schedule 1 to the Act is exercised.
6.     ADULT                                               CHILD
(i)        Bail is granted solely on the undertaking of    Bail is granted on the undertaking of the accused and on the
       the accused; or                                     following conditions -
(ii)        Bail is granted on the undertaking of the      (i)      that before the release of the accused (name of responsible
       accused and on                                               person)
            the following conditions:


                                                                       enter into an undertaking under cl.2(3)(c) of Part C of
                                                                       Schedule 1 to the Act; and
                                                               (ii)


                                                                                         (specify other conditions)
Reasons for grant / conditions of grant -




Date                                                           Signature
                                                                                           Authorised Officer/Justice/ or
                                                                                            Official Designation (title)
                                                 BAIL RECORD FORM
                                                BAIL Act 1982 Section 26(4)(b

                                                            Form 5
1. Accused
Details
                         Full Name

                         Address

                         Email Address /Fax
                         No.
                                                       GREEN Frederick

                                                       5 Jones St GOSNELLS

                                                       michaelsmith@hotmail.com.au
                                                                                                 Date of Birth

                                                                                                 Telephone
                                                                                                 No.
                                                                                                                     13 July 1982


                                                                                                                    08 9336 2563
                                                                                                                                       GRANTED
                                                                                                                                                        Form 5
                         (Insert brief particulars)
2. Charge(s)/
Appeal (s)/
Proceeding
                         Disorderly Conduct
                                                                                                                                       Always request a copy of
                                                                                                                                       the defendants record
3. Court
Number/s                 23625/09
4. Date of               Court Date:        Perth                                             Time:        10          am/pm
appearance for
which bail               Court Location: 501 Hay Street PERTH
considered:

                                                 BAIL REFUSED - GENERAL
Tick [] appropriate box
5. ADULT      Bail is refused. There is no condition which   CHILD
I could reasonably impose which would overcome the           Bail is refused. There is no condition which I could
ground(s) which influenced my decision to refuse bail. In    reasonably impose which would overcome the ground(s)
exercising my discretion I have had regard to:               which negate(s) any right of the accused to be released on
                                                             bail. I considered that a right to be released on bail is
                                                             negated by the following factor(s):

1.        If the accused is not kept in custody he/she may:                                                     Tick [] appropriate
                                                                                                                box
          (a) fail to appear in court in accordance with his/her bail undertaking;
          (b) commit an offence;
          (c) endanger the safety, welfare or property of a person;
          (d) interfere with witnesses or otherwise obstruct the course of justice.
2.        The need of the accused to be held in custody for his/her own protection.
3.        The grounds for opposing the grant of bail put forward by the prosecutor namely:

4.        The possibility that if the accused is not kept in custody the proper conduct of the trial may
          be prejudiced
5.        Any other ground
          (specify)

Reasons why above ground(s) apply (mention also any relevant factor referred to in the note below)

                                                                    Signature
Date
                                                                                              Authorised Officer/Justice/ or
                                                                                               Official Designation (title)

Note:         In considering (1) above regard shall be had to the following factors:
(a)           the nature and seriousness of the offence(s) including any other offence for which the accused is awaiting trial
              and the probable method of dealing with the accused for it/them if convicted;
(b)           The accused’s character, previous convictions, antecedents, associations, home environment, background,
              place of residence and financial position;
(c)           The history of previous grant(s) of bail to the accused;
(d)           The strength of evidence against him/her
                                             BAIL REFUSED – PARTICULAR GROUNDS
Tick [] appropriate box
         Bail is refused because -
         (a)        the accused is charged with a serious offence (as defined) committed while –
                    (i) on bail awaiting trial for a serious offence; or
                         (ii) at liberty under an early release order in respect of another serious offence; and
                         (iii) charged with breaching a violence restraining order.
         (b)        there are no exceptional reasons why the accused should not be kept in custody; and.

         Bail is refused because -
         (a)        the accused is a child; and
         (b)        no responsible person is willing to enter into an undertaking required by clause 2(3)(c) of Part C of Schedule
                    1 ; and
         (c)        the accused is not –
                    (i) over 17; or
                    (ii) of sufficient maturity to live independently without the guidance or control of a parent or guardian
Note
1.
         Section 6 need only be completed -

         (a)
                                                     BAIL GRANTED


                 if bail is granted for an initial appearance in court after an authorized officer has previously refused bail for that
                                                                                                                                          Form 5
                 appearance; or
         (b)     if it appears to the bail decision maker that the accused is dissatisfied with any condition imposed (not including a
                 condition under clause 2(3)(c) of Part C of Schedule 1 to the Act).
Note     In the case of a child it is mandatory for consideration to be given to the conditions referred to in clause 2(1a) of Part D
2.       of Schedule 1 to the Act.

Tick [] appropriate box
* Appropriate amendments to be made if the discretion in Clause 2(4) of Part C of Schedule 1 to the Act is exercised.
6.     ADULT                                              CHILD
(i)        Bail is granted solely on the undertaking of    Bail is granted on the undertaking of the accused and on the
       the accused; or                                     following conditions -
(ii)    Bail is granted on the undertaking of the         (i)      that before the release of the accused (name of responsible
       accused and on                                               person)
            the following conditions:


Not to enter railway property for 24 hours                             enter into an undertaking under cl.2(3)(c) of Part C of
                                                                       Schedule 1 to the Act; and
                                                               (ii)


                                                                                         (specify other conditions)
Reasons for grant / conditions of grant -

Minor nature of offences

               Date                                                          Sign JP & JP number
Date                                                           Signature
                                                                                           Authorised Officer/Justice/ or
                                                                                            Official Designation (title)
                                                                                                                                                       Form 6
                                                          Form 6                                                        [reg. 6]
                                                                                                                  ORIGINAL

                                                        Bail Act 1982
                                                        Section 28(2)

                                                BAIL UNDERTAKING
Surname:. …… JONES ……………Other names:……..Paul James
Date of birth……9…/…09…./…1969
Address:.......53 Black Road JARRAHDALE ..................................................................................
Telephone No…08 9447 5858 Fax No……N/A…….Email address pauljones1969@hotmail.com
Charge(s)/appeal/proceedings:
Possession of Heroin, Possession of smoking implement, Steal M/V
Court Nos.
PE 3456-7/00, PE 2563/00
Time and place of appearance:.......Perth Magistrates Court 501 Hay Street Perth
                                       (name and location of court)
on............MONday the..............4th .day of.....February........... 2001.........at .............a.m./p.m.                   Take care when signing this section.
Conditions to be observed during bail:
                                                                                                                                   Under the terms of the act as a
  $5,000 JP approved Surety. To reside at 53 Black Road JARRAHDALE
  Curfew between 8pm and 7am. To report daily to Armadale Police Station.
                                                                                                                                   Justice of the Peace You do not
                                                                                                                                   have the authority to release the
                                                UNDERTAKING
I, the abovenamed accused —
                                                                                                                                   Defendant if the warrant is issued
        UNDERTAKE —                                                                                                                out of a superior court. Refer to the
           (a)    to appear at the time and place and to comply with the conditions set out above;                                 top right hand corner of the Warrant
           (b)    that if I am notified by a judicial officer or court official of a different time, or a different
                  time and place, for my appearance, I will appear at the time, or at the time and place, so                       where a box will be ticked with the
                  notified;
           (c)    that if I fail to appear in court as required I will as soon as is practicable appear at the
                                                                                                                                   details of the originating court
                  court when it is sitting;
(1) Strike (1)AGREE to forfeit $...5,000.....to the State if I am convicted of the offence of failing to
out if not     appear as required.
applicable                                                 Accused to sign
                                                           ACCUSED
                                     CERTIFICATE AS TO UNDERTAKING
(2) delete       The above undertaking was entered into by the accused before me after I had (2) been
as               informed by him that he had read the undertaking/read the undertaking to him/had the
appropriate      undertaking translated to him.
                 Signature: .......................... Official Designation: ..........................
                                                       Date:....................................................
                  I acknowledge that I have been given a copy of the above bail undertaking and the form
                  Notice to Accused on the reverse of that copy.
                                                              Accused to sign
                                                                   ACCUSED

                                                             COURT COPY
                                                          Form 6                                                        [reg. 6]
                                                                                                                DUPLICATE




Details of accused:
                                                        Bail Act 1982
                                                        Section 28(2)

                                                 BAIL UNDERTAKING
                                                                                                                                                    Form 6
Surname:. …… JONES ……………Other names:……..Paul James
Date of birth……9…/…09…./…1969
Address:.......53 Black Road JARRAHDALE ..................................................................................
Telephone No…08 9447 5858 Fax No……N/A…….Email address pauljones1969@hotmail.com
Charge(s)/appeal/proceedings:
Possession of Heroin, Possession of smoking implement, Steal M/V
Court Nos.                                                                                                                         This form is to be sent to the
PE 3456-7/00, PE 2563/00                                                                                                           lockup/prison when the
Time and place of appearance:.......Perth Magistrates Court 501 Hay Street Perth
                                       (name and location of court)                                                                defendant is been held, as soon
on............MONday the..............4th .day of.....February........... 2001.........at ......10.....a.m./p.m.
Conditions to be observed during bail:
                                                                                                                                   as it is completed.
  $5,000 JP approved Surety. To reside at 53 Black Road JARRAHDALE
  Curfew between 8pm and 7am. To report daily to Armadale Police Station.

                                              UNDERTAKING
I, the abovenamed accused —
        UNDERTAKE —
           (a)  to appear at the time and place and to comply with the conditions set out above;
           (b)  that if I am notified by a judicial officer or court official of a different time, or a different
                time and place, for my appearance, I will appear at the time, or at the time and place, so
                notified;
           (c)  that if I fail to appear in court as required I will as soon as is practicable appear at the
                court when it is sitting;

(1) Strike       AGREE to forfeit $5,000 to the State if I am convicted of the offence of failing to
               (1)

out if not     appear as required ……………………Accused to sign
applicable
                                                    ACCUSED
                                      CERTIFICATE AS TO UNDERTAKING
(2) delete       The above undertaking was entered into by the accused before me after I had (2) been
as               informed by him that he had read the undertaking/read the undertaking to him/had the
appropriate      undertaking translated to him.
                 Signature: .......................... Official Designation: ..........................
                                                       Date:....................................................
                  I acknowledge that I have been given a copy of the above bail undertaking and the form
                  Notice to Accused on the reverse of that copy.
                                                              Accused to sign                                                      This is the authority to release
                                                                   ACCUSED
                                            CERTIFICATE TO AUTHORISE RELEASE
                                                                                                                                   the prisoner, if this is not signed
                 I certify for the purposes of section 11(3) of the Act that the accused is entitled to be at
                 liberty on bail as provided in section 11 of the Act.
                                                                                                                                   then the prisoner will not be
                 Signature: JP TO SIGN Official Designation: JP and JP Number                                                      released, even if everything else
                                               COPY FOR LOCKUP/PRISON                                                              is signed.
                                                                                                                                            Form 6
                                                               Form 6                                                            [reg. 6]
                                                                                                                        TRIPLICATE

                                                           Bail Act 1982
                                                            Section 28(2)

                                                    BAIL UNDERTAKING
Details of accused:
Surname:. …… JONES ……………Other names:……..Paul James
Date of birth……9…/…09…./…1969
Address:.......53 Black Road JARRAHDALE ..................................................................................
Telephone No…08 9447 5858 Fax No……N/A…….Email address pauljones1969@hotmail.com
Charge(s)/appeal/proceedings:
Possession of Heroin, Possession of smoking implement, Steal M/V
Court Nos.
PE 3456-7/00, PE 2563/00
Time and place of appearance:.......Perth Magistrates Court 501 Hay Street Perth
                                        (name and location of court)
on............MONday the..............4th .day of.....February........... 2001.........at .....10....a.m./p.m.
Conditions to be observed during bail:
  $5,000 JP approved Surety. To reside at 53 Black Road JARRAHDALE
  Curfew between 8pm and 7am. To report daily to Armadale Police Station.
                                               UNDERTAKING
I, the abovenamed accused —
        UNDERTAKE —
           (a)  to appear at the time and place and to comply with the conditions set out above;
           (b)  that if I am notified by a judicial officer or court official of a different time, or a different
                time and place, for my appearance, I will appear at the time, or at the time and place, so
                notified;
           (c)  that if I fail to appear in court as required I will as soon as is practicable appear at the court
                when it is sitting;

(1) Strike       AGREE to forfeit $5,000 to the State if I am convicted of the offence of failing to
               (1)

out if not     appear as required ……………………Accused to sign. ................................................
applicable                                          ACCUSED
                                        CERTIFICATE AS TO UNDERTAKING
(2) delete       The above undertaking was entered into by the accused before me after I had (2) been
as               informed by him that he had read the undertaking/read the undertaking to him/had the
appropriate      undertaking translated to him.
                 Signature: .......................... Official Designation: ..........................
                                                       Date:....................................................
                  I acknowledge that I have been given a copy of the above bail undertaking and the form
                  Notice to Accused on the reverse of that copy.
                      ................................................ Accused to sign...............................................
                                                                         ACCUSED
                                                                       TO THE ACCUSED
                 THE NOTICE ON THE REVERSE OF THIS FORM SETS OUT YOUR OBLIGATIONS
                 AND THE CONSEQUENCES OF YOUR FAILURE TO COMPLY WITH THEM. YOU
                 SHOULD READ THE NOTICE OR REQUIRE THE PERSON WHO TAKES YOUR
                 BAIL UNDERTAKING TO READ IT TO YOU OR HAVE IT TRANSLATED TO YOU.
                                                        NOTICE TO ACCUSED



          1. Appearance in court
                                                    BAIL ACT 1982 PART V Section 28(2)
                                                                   Form 7                                                                                    Form 7
                You must appear at the time and place mentioned in your undertaking and surrender yourself into the custody of the
                court. You must then remain in custody until you are entitled to be released.

          2. Bail Conditions
                  While you are on bail you must also observe the conditions set out in your undertaking.
                  If you fail to comply with a condition set out in your undertaking imposed for the purposes mentioned in clause 2(2)(c)
                  or (d) of Part D of Schedule 1 to the Act you commit an offence. The penalty for the offence is a fine up to $10,000 or
                  imprisonment for up to 3 years, or both.

          3. Notification Of Later Time / Place
                 If you are notified either by a judicial officer or by a court official of a different time, or a different time and place, for
                 your appearance, then you must appear at the time, or at the time and place, so notified. Such notification may be
                 given to you by a judicial officer at a hearing. If a notification is given to you by a court official it must be in writing
                 handed to you personally, or sent to you by post or electronic communication.
                                                                                                                                                      The rear of the third copy of the
          4. Failure to Attend                                                                                                                        form 6 (when using the pre-carboned
                  Should you fail to appear in court as required you must as soon as is practicable appear at the court when it is sitting.
                                                                                                                                                      copies) includes the form 7.
          5. Consequences Of Non-Appearance
                If, without reasonable cause, you do not appear in court as mentioned in paragraph 1 or 3 above, you commit an
                offence. If you do not appear as mentioned in paragraph 4 above you commit a further offence. The penalty for each                    Computer generated copies of the
                offence is a fine of up to $10,000 or imprisonment for up to 3 years, or both.
                You will also be liable to an order to pay the amount of money, if any, referred to in your bail undertaking.
                                                                                                                                                      forms will have a separate sheet to
                If you non-appearance continues for more than 1 year that amount will be automatically forfeited.                                     cover the form 7.
                You may also be ordered to pay some or all the cost of your return to custody.
                In addition, any surety will be liable to an order to pay the amount of money referred to in his/her surety undertaking.
                                                                                                                                                      Make sure that the Defendant is
          6. Change of Address etc.
                You must, in writing, notify the court at which you are to appear of any change of residential address. It is an offence              aware of the conditions stated on
                not to do so, without reasonable cause.                                                                                               this form.
                The maximum penalty for the offence is fine up to $1000.

          7. When Court May Reconsider Bail                                                                                                           You don’t need to read out every
                                                                                                                                                      clause but you should reinforce areas
                 Your bail may be interrupted and you may be brought before the court for reconsideration of bail in the following
                 situations:
       a)           if your surety or a police officer reasonable believes that:                                                                      relating to non-appearance and
(i)                           you are not likely to appear in court as required; or
(ii)                a bail condition is being, has been or is likely to be broke by you,                                                              change of address
              b) if a police officer reasonably believes that the court should reconsider your surety or the security (if applicable)
              c) if your bail is for an appeal and a police officer reasonably believes that you have been guilty of delaying the hearing of
                 the appeal; or
              d) if your surety applies to the court for cancellation of his/her surety undertaking.

                 In case of urgency where your surety reasonably believes that you are not likely to appear in court as required or that
                 you have broken any bail conditions, he/she may arrest you and hand you over to a police officer to be taken before
                 the court for reconsideration of bail.

                 In the case of an accused who is a child, the references to ‘surety’ in this part of the form includes the
                 ‘responsible person’.

          8. Interruption Of Bail On Application By Responsible Person
                  If you are a child and the responsible person wants to have his or her undertaking cancelled, you may be tak en into
                  custody until the application is dealt with by a police officer and another responsible person takes over.

          Footnote:         A responsible person is a person who gives an undertaking under clause 2(3)(c) of Part C of Schedule 1 to ensure that a
                            child does what is required by his/her bail undertaking.
                                                                                                     Form 8                                                      [reg. 6]



                                                                                                                                                                                                                  Form 8
                                                                                            Bail Act 1982

                                                                              Sections 35 and 37(1)(a) & (c)

                                                 PART A — NOTICE TO SURETY AS TO TERMS OF BAIL
1.     NAME AND ADDRESS OF ACCUSED
       .....SMITH ................................................David......................................................................................................................
            Surname                                                Other Names
       ......53 Black Road Jarrahdale .............................................................................................................................................
             Address
2.     CHARGE(S)/APPEAL/PROCEEDINGS
       ....................... Possession of Heroin, Possession of smoking implement, Steal M/V
       ………………………………………………………………………………………………………………............................
3.     COURT AND CHARGE NOS. ..... PE 3458-9/00, PE 2564/00..................................................................................

4.     WHERE AND WHEN ACCUSED REQUIRED TO APPEAR Perth Magistrates Court 501 Hay Street Perth
                                     Name and location of court
       on............MONday the..............4th .day of.....February........... 2001.........at .....10....a.m./p.m
5.     BAIL HAS BEEN GRANTED TO THE ACCUSED TO APPEAR AS ABOVEMENTIONED, ON THE FOLLOWING                                                                                                                    The surety must
                                                                                                                                                                                                             understand this
       TERMS AND CONDITIONS.
           $5,000 JP approved Surety. To reside at 53 Black Road JARRAHDALE
           Curfew between 8pm and 7am. To report daily to Armadale Police Station.                                                                                                                           undertaking and the
                                                                           SIGNATURE AND DESIGNATION OF SURETY APPROVAL OFFICER                                                                              consequences if the
       ................Sign JP JP Number ........................                                                                                                                                            defendant does not
Warning
                                                 PART B — DECLARATION BY PROPOSED SURETY
                                                                                                                                                                                                             appear in court
It is an offence punishable by a fine of up to $1 000 or imprisonment for up to 12 months, or both, to knowingly or recklessly give
false information for the purpose of obtaining approval as a surety.
1.     Proposed Surety
       ……SMITH……………………………………………Donna Jane ………………………………………………………
       Surname……………………………………………….. Other names…………………………………………………………...

2.     Date of birth…………7 June 1984……………………


3.     Occupation..............Hairdresser................................................................................................................
       Employer details                Fred’s Hair Shop ………………………………………………………………….
4.     Address....... 53 Black Road JARRAHDALE                                                    ..............................................................................
       ...........................................................................................................................................................................
       Telephone No...... 08 9447 5858 ............Fax No………N/A……..
       Email address………N/A……………………………………………………..
5.           (a)        Relationship (1) to accused
                        .......Wife ......................................................................................................................................................................
                                                       (1) e.g. parent, friend, employer.

             (b)        Period for which known defendant
                                                                                     Six months.......................................................................................................

                                                                                                                                                                                     (See reverse.)
                                                                                                                Form 8                                                          [reg. 6]
6.Financial position
     Assets                                                                                                                                                                           Value ($)
     Real estate (address)…………………………………………………………………………………...
     .....................................................................................................................................................................
     Vehicle(s) (make, model and reg.no)………………2004 Nissan Pulsar 1BFF 449……..................
      …………………………………………………………. …………………………………………….
     Electrical equipment (TV, stereo, DVD etc)………………………………………………...................
     .....................................................................................................................................................................
                                                                                                                                                                                      ......................................
                                                                                                                                                                                      ......................................
                                                                                                                                                                                       .......................$13,000
                                                                                                                                                                                      ......................................
                                                                                                                                                                                       .......................$10,000
                                                                                                                                                                                      ......................................
                                                                                                                                                                                                                                                             Form 8
     Furniture (excluding white goods)……………………………………………………………………..                                                                                                                    .......................$23,000
     …………………………………………………………………………………………………………                                                                                                                                         ……………………….
     Bank accounts………ANZ account 025 325 – 5232222                                                                                                                                     ………………$8,000
     …………………………………………………………………………………………………………                                                                                                                                         …………………….....
     Shares………………………………………………………………………………………………….                                                                                                                                     ……………………….
     …………………………………………………………………………………………………………                                                                                                                                         ……………….............
      Other (please state)……………………………………………………………………………………                                                                                                                            ……………………….
     ……………………………………………………………………………………………....................                                                                                                                          …………………….....
     Liabilities                                                                                                                                                                      Value ($)
     Mortgage(s) (specify financial institution)………………………………………………......................                                                                                              ……………………….
     …………………………………………………………………………………………………………                                                                                                                                         ……………………….
     .....................................................................................................................................................................            ……………………….
     Fines (including fines registered with the Fines Enforcement Registry)………………….....................                                                                               ……………………….
     …………………. ……………………………………………………………………………………..                                                                                                                                      ……………………….
     Credit cards……………………………………………………………………………………………                                                                                                                                  ………………$2,000
     .....................................................................................................................................................................            ……………………….
     Loans………………………………………………………………………………………...................                                                                                                                        …………………..…...
     …………………………………………………………………………………………………………                                                                                                                                         ……………………….
     Other (please state)…………………………………………………………………………………….                                                                                                                            ……………………….
     …………………………………………………………………………………………………………                                                                                                                                         ……………………….
7.            Character
                              Do you have any convictions, or are any criminal proceedings pending against you? (tick appropriate box)
                               YES  NO
                              If yes, give details.........................................................................
                              .......................................................................................................
8.                            Have you been, or are you at present, a surety for any person? (tick appropriate box)
                               YES  NO
                              If yes, give details..............Previously surety for husband.....
9.            I, ..........Donna Jane SMITH.................hereby apply for approval of myself as a surety.
                       (full name)
              I DECLARE THAT —
                     the above particulars relating to me are true;
                    (a)
                     I have not received any money or other compensation, or promise of money or other compensation, to cover any liability I
                    (b)
                     may incur as a surety.

                                                                                                                                                                                                                                              ** do/do not **
              I ACKNOWLEDGE that I have been given —
                 (a) Part A of Form 8 (Notice to Surety as to Terms of Bail) duly completed; and
                 (b) Form 9 (Information for Proposed Surety).
                    I STATE that —
                    (a)          I do/do not * agree to my obligations as a surety being extended to any time, or time and place, appointed for the accused’s                                                                           ONE MUST BE DELETED
                                 appearance which is different from that shown in paragraph 4 of the notice.
                                 I do/do not * require notice to be given to me of any such different time or time and place.
                                                                                                                                                                                                                                        if an option is not deleted
                    (b)
                    (c)          I do/do not* agree to my obligations as a surety being extended to a different time substituted during trial.
                                 *
                                     show which
                                                                Signature of applicant...................................................................
                                                                Date……………/………./……………
                                                                                                                                                                                                                                        at (c) the defendant may
NOTICE TO PROSECUTOR                                                                                                                                                                                                                    spend time in custody after
                                                                                                                                                                                                                                        their next appearance
Prosecutor notified of application orally/in writing
Date...............Time.....................Name of person notified.......................................................................................................................................

                                                                                                                                                                                                                                        unnecessarily.
                                                 Signature....................................................................................................................................................
                                                 Designation................................................................................................................................................
Response by prosecutor (if any):
..................................................................................................................................................................................................
DECISION
Applicant approved/not approved
Reasons for refusal to approve:
.................................................................................................................................................................................................. ..................................      If you do not approve the
Applicant informed of reasons:
                                                                                                                                                                                                                                           applicant you must tell
                                                                                                                                                                                                                                           them why.
..................................................................................................................................................................................................
Signature and designation of surety approval officer……………JP to Sign, JP and JP number……………...
                                                                                           Form 8                                                                                            [reg. 6]
                                                                                         Bail Act 1982




1.       NAME AND ADDRESS OF ACCUSED
                                                                             Sections 35 and 37(1)(a) & (c)

                                                   PART A — NOTICE TO SURETY AS TO TERMS OF BAIL


         .....SMITH ................................................David......................................................................................................................
                                                                                                                                                                                                                Form 8
              Surname                                                Other Names
         ......53 Black Road Jarrahdale .................................................................................................................... .........................
               Address
2.       CHARGE(S)/APPEAL/PROCEEDINGS
         ....................... Possession of Heroin, Possession of smoking implement, Steal M/V
         ………………………………………………………………………………………………………………............................
3.       COURT AND CHARGE NOS. ..... PE 3458-9/00, PE 2564/00..................................................................................

4.       WHERE AND WHEN ACCUSED REQUIRED TO APPEAR Perth Magistrates Court 501 Hay Street Perth
                                                                                                                                                                                                        Same as page 1
                                        Name and location of court
         on............MONday the..............4th .day of.....February........... 2001.........at .....10....a.m./p.m
5.       BAIL HAS BEEN GRANTED TO THE ACCUSED TO APPEAR AS ABOVEMENTIONED, ON THE FOLLOWING TERMS
         AND CONDITIONS.
             $5,000 JP approved Surety. To reside at 53 Black Road JARRAHDALE
            Curfew between 8pm and 7am. To report daily to Armadale Police Station.


                                                                                       SIGNATURE AND DESIGNATION OF SURETY APPROVAL OFFICER
 (1) For an                                                                                  PART C
explanation see
Form 9.                                                                               SURETY UNDERTAKING
(2) Delete (b) if
                       I, Donna Jane SMITH of 53 Black Road Jarrahdale
surety’s
obligations are        undertake and agree, to forfeit $..5,000...to the State, in terms of section 49 of the Bail Act 1982 (1), if the
not to cover this.     abovenamed accused.
(3) Delete words           (a)    fails to appear at the time and place specified in Part A above; or
in brackets if                    (2)
notice is not              (b)        fails to appear at a different time, or time and place, at which he is duly required to appear (provided
required.                         that I have been notified of such time, or time and place) (3); or
                           (c)    upon a failure to so appear, also fails to appear as soon as is practicable thereafter at the court when it is
                                  sitting; or
(3A) Delete (d)               (d) fails to appear at a different time substituted during his trial (3A).
if surety’s
obligations are                Under section 44(4) of the Act the undertaking in (d) applies despite an amendment to the bail conditions
not to cover this.             if a statement that the amendment is of a minor nature has been made under section 31A(4) of the Act.
                       I acknowledge that before entering into this undertaking (4) I read/had read to me/had translated to me Part A of this
                       form duly completed, Form 9, and this undertaking.
                                                             Signature of Surety............................................................................................
(4) Delete as          The above undertaking was entered into by the abovenamed, before me after I had (4) been informed by him that he
appropriate.           had read/read to him/had translated to him Part A of this form duly completed, Form 9 and this undertaking; and
                       after I had ensured that he had complied with all conditions imposed on him.
                                                           Signature……........................................................................................................
                                                            Official Designation..................................................... Date………../……./…...
                       I acknowledge that I have been given a copy of the above undertaking as completed
                                                          Signature of Surety…………………………………….Date.........../.........../........
                                                        ENDORSEMENT UNDER SECTION 45(3)
                       I certify that on...Friday 1 February 2001....I required the accused to appear at ... Perth Magistrates Court.....on
                       .....................Mon day the.............4th day of ....February 20 01............ at....10 ..a.m./p.m. and that, under
                       section 45(1)(a) of the Act, I orally notified the surety thereof.
                                                                      Signature.............................................................................................................
                                                                     Official Designation................................................... Date.................................
                       Authorised Officer who is to issue certificate under section 11(3) of the Act advised (show date, time, place and
                       name of person advised)......................................................................................
                                                                                                               Signature ....JP to sign & JP Number.........................
                                                                                           Form 8                                                                                            [reg. 6]



                                                                                                                                                                                                               Form 8
                                                                                         Bail Act 1982

                                                                             Sections 35 and 37(1)(a) & (c)

                                                   PART A — NOTICE TO SURETY AS TO TERMS OF BAIL
1.       NAME AND ADDRESS OF ACCUSED
         .....SMITH ................................................David......................................................................................................................
              Surname                                                Other Names
         ......53 Black Road Jarrahdale .................................................................................................................... .........................
               Address
2.       CHARGE(S)/APPEAL/PROCEEDINGS
         ....................... Possession of Heroin, Possession of smoking implement, Steal M/V
         ………………………………………………………………………………………………………………............................
3.       COURT AND CHARGE NOS. ..... PE 3458-9/00, PE 2564/00..................................................................................                                                         Same as page 1
4.       WHERE AND WHEN ACCUSED REQUIRED TO APPEAR Perth Magistrates Court 501 Hay Street Perth
                                        Name and location of court
         on............MONday the..............4th .day of.....February........... 2001.........at .....10....a.m./p.m
5.       BAIL HAS BEEN GRANTED TO THE ACCUSED TO APPEAR AS ABOVEMENTIONED, ON THE FOLLOWING TERMS
         AND CONDITIONS.
             $5,000 JP approved Surety. To reside at 53 Black Road JARRAHDALE
            Curfew between 8pm and 7am. To report daily to Armadale Police Station.

                                                                                        SIGNATURE AND DESIGNATION OF SURETY APPROVAL OFFICER
 (1) For an                                                                                   PART C
explanation see
Form 9.                                                                                SURETY UNDERTAKING
(2) Delete (b) if
                        I, Donna Jane SMITH of........53 Black Road Jarrahdale ...............................................
surety’s
obligations are         undertake and agree, to forfeit $..5,000..........to the State, in terms of section 49 of the Bail Act 1982 (1), if the
not to cover this.      abovenamed accused.
(3) Delete words
in brackets if
notice is not                  (a)        fails to appear at the time and place specified in Part A above; or
required.                                 (2)
                               (b)            fails to appear at a different time, or time and place, at which he is duly required to appear (provided
                                          that I have been notified of such time, or time and place) (3); or
                               (c)        upon a failure to so appear, also fails to appear as soon as is practicable thereafter at the court when it
                                          is sitting; or
(3A) Delete (d)                (d) fails to appear at a different time substituted during his trial (3A).
if surety’s
obligations are                  Under section 44(4) of the Act the undertaking in (d) applies despite an amendment to the bail
not to cover this.               conditions if a statement that the amendment is of a minor nature has been made under section 31A(4) of
                                 the Act.
                        I acknowledge that before entering into this undertaking (4) I read/had read to me/had translated to me Part A of
                        this form duly completed, Form 9, and this undertaking.
                                                                                                 Signature of Surety...................Surety must sign.......................
         Form 9
  You must make sure that the
  Surety understands the possible
  consequences if the accused does
  not attend court.




                            Page 3




Page 2
    NOTICE TO ACCUSED/SURETY OF DIFFERENT TIME AND PLACE FOR APPEARANCE
                                BAIL ACT 1982
                                                      Sections 31 and 45 (1) (b) & (c)
                                                                     Form 10
1. Accused Details      Full Name

                        Address


                        Email Address/ Fax No.
                                                                                                 Date of Birth


                                                                                                 Telephone No.(s)
                                                                                                                                               Form 10
                        (Insert brief particulars)
2. Charge(s)/
Appeal (s)/
Proceeding

3. Court Ref No/s
On receipt of this notice, the accused’s obligation to appear is extended in accordance with the date, time and location mentioned below.

4. Surety /             Full Name
responsible
persons details
                        Address                                                                  Date of Birth


                        Email Address/ Fax No.                                                   Telephone
                                                                                                 No.(s)

On receipt of this notice, your liability as a surety is extended to ensure the appearance of the accused to meet their obligation to appear
at the date, time and location mentioned below.

                                                     APPEARANCE DETAILS
YOU ARE HEREBY NOTIFIED, under section 31 and 45(1)(b) and (c) of the Bail Act 1982, that the accused is now required
to appear at:

                        On                 day       the               day   of                      20           at               am/pm
5. Time and place
of appearance           Court:

                        No:                                Street:
                        Suburb:                                                                      Postcode:
Signature:                                                                          Date:

Judicial Officer / Justice / Registrar / Authorised Person




                                                                                                                       Original = Accused
    NOTICE TO ACCUSED/SURETY OF DIFFERENT TIME AND PLACE FOR APPEARANCE
                                BAIL ACT 1982
                                                      Sections 31 and 45 (1) (b) & (c)
                                                                     Form 10
1. Accused Details      Full Name

                        Address                                                                  Date of Birth                                 Form 10
                        Email Address/ Fax No.                                                   Telephone No.(s)

                        (Insert brief particulars)
2. Charge(s)/
Appeal (s)/
Proceeding

3. Court Ref No/s
On receipt of this notice, the accused’s obligation to appear is extended in accordance with the date, time and location mentioned below.

4. Surety /             Full Name
responsible
persons details
                        Address                                                                  Date of Birth


                        Email Address/ Fax No.                                                   Telephone
                                                                                                 No.(s)

On receipt of this notice, your liability as a surety is extended to ensure the appearance of the accused to meet their obligation to appear
at the date, time and location mentioned below.

                                                     APPEARANCE DETAILS
YOU ARE HEREBY NOTIFIED, under section 31 and 45(1)(b) and (c) of the Bail Act 1982, that the accused is now required
to appear at:

                        On                 day       the               day   of                      20            at              am/pm
5. Time and place
of appearance           Court:

                        No:                                Street:
                        Suburb:                                                                      Postcode:
Signature:                                                                          Date:

Judicial Officer / Justice / Registrar / Authorised Person
                                                                                            Duplicate – Surety or Responsible Person
     NOTICE TO ACCUSED/SURETY OF DIFFERENT TIME AND PLACE FOR APPEARANCE
                                 BAIL ACT 1982
                                                         Sections 31 and 45 (1) (b) & (c)
                                                                        Form 10
1. Accused Details         Full Name




                                                                                                                                               Form 10
                           Address                                                               Date of Birth


                           Email Address/ Fax No.                                                Telephone No.(s)

                           (Insert brief particulars)
2. Charge(s)/
Appeal (s)/
Proceeding

3. Court Ref No/s
On receipt of this notice, the accused’s obligation to appear is extended in accordance with the date, time and location mentioned below.

4. Surety /                Full Name
responsible
persons details
                           Address                                                               Date of Birth


                           Email Address/ Fax No.                                                Telephone
                                                                                                 No.(s)

On receipt of this notice, your liability as a surety is extended to ensure the appearance of the accused to meet their obligation to appear
at the date, time and location mentioned below.

                                                        APPEARANCE DETAILS
YOU ARE HEREBY NOTIFIED, under section 31 and 45(1)(b) and (c) of the Bail Act 1982, that the accused is now required
to appear at:

                           On                  day      the               day   of                   20            at              am/pm
5. Time and place
of appearance              Court:

                           No:                                Street:
                           Suburb:                                                                   Postcode:
Signature:                                                                            Date:

Judicial Officer / Justice / Registrar / Authorised Person

Service details            Accused person given this notice by:
Tick [] appropriate box         personal service effected at (address):
                                 facsimile
                                 email
                                 postal service (address)

                           On                  day      the               day   of                   20            at              am/pm
                           Signature of Registrar / Authorised                                       Date
                           person:

Service details            Surety / responsible person given this notice
                           by:
Tick [] appropriate box         personal service effected at (address):
                                 facsimile
                                 email
                                 postal service (address)

                           On                  day      the               day   of                   20            at              am/pm
                           Signature of Registrar / Authorised                                       Date
                           person:
                                                                                                                 Triplicate – Court Copy
                                 UNDERTAKING BY RESPONSIBLE PERSON
                                           BAIL ACT 1982
                                                  Schedule 1, Part C, clause 2(3)(c)
                                                              Form 12
1. Accused
Details
                   Full Name

                   Address

                   Email Address/ Fax No.

                   (Insert brief particulars)
                                                     Pamela Lee JONES

                                                     15 Smith Street ARMADALE
                                                     jones@hotmail.com.au
                                                                                            Date of Birth

                                                                                            Telephone No/s
                                                                                                                       12 May 1988

                                                                                                                       08 9200 4658
                                                                                                                                                                 Form 12
2. Charge(s)/
Appeal (s)/        Disorderly Conduct, False Name, Resist Arrest
Proceeding
Court Ref
No/s
                   JO 1234-6/07                                                                                                             The main difference between this form
                       Monday
                        O          day the      20th day of                       March           20 08           at     10.00      am/pm   and the surety undertaking is that the
                        n
3. Time &               Court: Joondalup Magistrates Court
                                                                                                                                            Responsible Person guarantees
Place of
of                      No: 21                            Street: Reid Promenade
                                                                                                                                            performance and appearance where as
Appearance                                                                                                                                  the Surety only guarantees appearance
                        Suburb: Joondalup                                                                Postcode: 6027

4. Conditions           Curfew from 7pm – 8 am.
to be
observed                Must reside at 41 Atwell Street ARMADALE
during bail

                                                           UNDERTAKING
5. Applicant       Full Name                                                                      Date of Birth               1 July 1973
details                                                  Sullivan Paul STORAGE
                   Relationship to accused                                                        Period known                20 years
                                                Uncle                                             accused
6. Address              41 Atwell Street ARMADALE


                        Responsible person to write name
I, (full name)
Give the following undertakings:
a) I will ensure that the accused appears at the time and place specified above.
b) if under section 31(3) of the Act, the accused is required to appear at a different time, or a different time and place, I will
ensure that the accused, appears at that time and place if I have been notified in writing of the different requirement.
c) If the accused fails to appear as required, I will ensure that the accused, as soon as is practicable, appears at the court at
which the accused was required to appear when that court is sitting.
d) I will ensure that the accused complies with the bail conditions set out above.

Signature of Responsible                                                                             Date:
Person:                                    Responsible person to sign                                                  Date


                                                CERTIFICATE AS TO UNDERTAKING

The above undertaking was entered into                 Tick [] appropriate box
by the responsible person before me after
                                                           had read the undertaking
I had been informed by him/her that
he/she:                                                    had the undertaking read to him/her
                                                           had the undertaking translated to him/her
                   JP to Sign
Signature:                                                                                       Date:        Date

Judicial Officer / Justice / Registrar / Authorised Officer     Justice of the Peace             JP Number
I acknowledge that I have been given a copy of the above undertaking.
Signature of Responsible                        Responsible person to sign                       Date:        Date
Person:
                                                                                                                        Court Copy


                                                                                                                                                                       Responsible persons copy
     JP Branch
    08 9425 2896
www.dotag.wa.gov.au
jps@justice.wa.gov.au

   November 2009

				
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