COMPLETE IF YOU WISH TO DISPUTE AN EXPIATION NOTICE AND TAKE THE MATTER TO COURT
Enquiries: visit www.police.sa.gov.au/enb or phone 1300 920 362 Monday – Friday, 9:00am to 5:00pm.
NOTICE DETAILS
I,
(notice holder full name)
of
(address)
authorised to speak for Company Name (if applicable):
Email Address:	Phone:
Expiation Notice Number:
Disqualification Notice Number (if applicable):
ELECTION TO BE PROSECUTED / PAYMENT
Complete Section A OR Section B (one section only)
*In the case of multiple offences, you may choose to take one/two offence(s) to court and pay for the other offence(s).
SECTION A	( select applicable)
Wish to elect to be prosecuted for the entire notice (all offences).
SECTION B	( select applicable)
Wish to elect to be prosecuted for:	Offence 1	AND	Pay for the remaining offence(s)*:	Offence 1
Offence 2	Offence 2
Offence 3	Offence 3
REASONS FOR DISPUTE
I dispute the offence(s) for the following reasons: ELECTION TO BE PROSECUTED / PAYMENT
(You may wish to complete this statement but are not required to do so. Attach further documentation if required.)
Signature:	Date:	/ /
Send completed and signed Election to be Prosecuted to South Australia Police, Expiation Notice Branch
Email to: ENB@police.sa.gov.au or Post to: Expiation Notice Branch, GPO Box 2029, ADELAIDE SA 5001