Citation Notification Form | Shoalhaven District

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Respondants Name

Club/Affiliate/Nil

Date of Notification

Alleged Offence

Level of Citation

Potential Penalty

Early Guilty Plea Available * Required

Yes

No

Early Plea Penalty Offer

Date of Judiciry Meeting (if required)

Time of Judiciary Meeting (if required)

Judiciary Chairmans Name

Thanks for submitting!

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