Rego*:

Make*:

Model*:

Colour*:

Year:

Town*:

Street*:

Side of Street*:

North,
South,
East,
West

P-Code*:


If P106 (OTL):
Dist from sign (front)

Dist from sign (rear)

Restriction

Time Over
0-30mins $12,
30-60mins $15,
60-120mins $21,
120-240mins $30,
240-360mins $42,
360+mins $57


Officer#*:

Notes: