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Men-reg
PE-reiz io• Neil
Section 47EAB of the Road Traffic Act 1961
Section 40 K of the Road Traffic Act 1961
Notice ilyriter
PD2911
'''71017;i*
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FAMILY NAME: .._ .
. LICENCE NUMBER:
cle-Atir-c- CC71, r
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GIVEN NA
Class P LQ
BIKE Other
State of Issue:.
. ,
.
N
ADDRESS: ..—_
LIC. CHECK CONDUCTED.! N• LIC. PRODUCEDP/
SUBURB! TOWN:
PHONE: t
__....:.._._4.—_._..._. . DATE OF BIRTH:
SEX: M 0.
ALLEGATION -TICK ores oat sox
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--1 k <10 3 (" r 5
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At about
.
. arneon
at
(location)
It is alleged that you whilst driving or attempting to put a Vehicle In motion:
Erixceedeci the prescribed concentration of alcohol
O prevideaa positive oral fluid sample to a prascrIbed drug
O refusecllfalled to comply with request for oral fluid I blood sample! alcotest / Breath Analysis
O were under the Influence of intoxicating liquor or drug (DUI)
DIRECTION - CAN 11CK Mit•
•
•
L
AME OFFICER
.
- irccerr t4Pa t M I 0.) cA
'
Nrii
0:4c Di Pt
As a result of this InfonnatioVi,
'
'' a member ci-e of e police forCep.m to mioweettietealcrpveereect.
Rank
.
D
believe on reasonable grounds that you are not fit to drive a vehicle because of the consumption of alcohol or a drug.
I direct you to:
A O Vacate the drivers seat.
E O NOT DRIVE ANY OTHER VEHICLE until permitted to do so by this
notice.
B @ Not occupy the drivers, seat until permitted to do so by this notice.
F O Immobilise the vehicle.
C O Leave the vehicle
G O Secure the vehicle and surrender to a police officer all keys to the
D O Not enter the vehicle until permitted to do so by this notice.
vehicle that are in your immediate possession or are in the vehicle.
Keys! component to the vehicle reg. no.
being driven by the subject at the time of the issue of this direction will be able to be collected by the driver or any person who Is lawfully entitled to
them and who makes a request at a 24 how police station nominated below:
rota
This direction will remain in force for a period of:
K O 24 hours - DUI - drugs and/or alcohol
H O 5 hours - positive to tetrahydrocannabinol (THC)
L tre hours - positive alcohol (less than - 0.080 (Category Onel)
I O 24 hours - positive to mothyIamphetamIne/ Methylonedloxy-
M O 12 hours - positive alcohol (0.080 - 0.149 [Category Two))
methamphetamine (MDMA)
N O 24 hours — positive alcohol (0.150 < (Category Three))
J O 24 hours - Refuse/Tail to Comply with direction to supply oral fluid
O O 24 hours — Refuse I Fail to Comply with direction to
I blood sample supply breath sample
IT IS AN OFFENCE TO FAIL TO COMPLY WITH THIS DIRECTION — Penalty $5,000
C‘
This notice was issued and given at
QS PM onefa issuing Officer's Signature "..1.•
Name:
.
ACKNOWLEDGEMEN
I acknowledge receipt of this notice at the time and date recorded above.
Signature
Name: —StaCQ1/4••••E`4
C'er C.t CC
O
Diver / siir•
Rank:
1 C
ID
L.
trr
Witness's Signature
-Mae RefusecH-tMatarr —tiralgn
/
Accepted Order (delete as applicable)
IDr
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wnum la an. fa SRI nil...Wallin Iran.
DWAIN! IN (WIN
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Road Traffic (Miscellaneous) Regulations 1999
Schedule 1
Prescribed oral advice and written notice
Part B
: ftl r '.;:'.ii • tritten notice for the purposes of section 47K(2a)(a)
1,7 1:11.E PS of Road Traffic Act 1961
.
9 IRO'S:
: Act In relation to results of breath analysis pEcs-scr.
__
irtuEti tirinEs:
jtAct.,..jo. tut-. i.:NP.CiL irF.*WiRT ItiC 11F.31BER:
affence against section 476(1) of the Road Traffic Act 1961 if the person —
ehicle, or
:motor vehicle in motion, in his or her blood the prescribed concentration of alcohol (as defined in section
en analysed by means of a breath analysing instrument which indicated that the
!^" NS' i of alcohol was present in your blood.
SPNPLE
iT
0_05 hat you have committed the offence described above.
dire skiLi:T.EST
.0.59 sELrTEST
4i;anPla t! L c 2:
oPTE:
TiiEri.IEFT: EcT
27:40TE5::
BrAC
'ct cTEST fT
111-0 nalysis result
`fence described above or an offence against section 47(1) of the Road Traffic
-rva the influence of liquor), the result of the breath analysis will be presumed
.
:oncentration of alcohol in your blood at the time of the analysis and throughout
ction 47K(1), (lab)).
st you for such an offence, you will be able to challenge the accuracy of the
1.5L
-
[repeated 3 times]
-
:1
-
[repeated 7 times]
11+IfE:
±..1:15 rs iIL
.050
:-./..e.ifra.)L IN 219
.
•
-
.
•
•
•
_
_
-
[repeated 4 times]
•
•
•
,
-
[repeated 13 times] a of your blood taken and analysed as described below AND
ysis of the blood sample shows that the breath analysing instrument gave
ling of the concentration of alcohol present in your blood (section 47K(1a)).
test rile of your blood taken and analysed if you wish.
must request the breath analysis operator to supply you with an approved
ist sign a written request form for the kit and should retain a copy of the
sed promptly to a hospital or a medical practitioner [`or registered nurse]
Jest that a sample of your blood be taken (using the blood test kit).
rther alcohol before the sample is taken.
est kit.
r ["or registered nurse] taking the sample of your blood will divide it and
^leis and seal the containers. One container will be delivered to you —
this container.
i to you by the medical practitioner ['or registered nurse] — the original
'
!la you which you should retain.
have the blood sample (in the container delivered to you) analysed
— ' ne the concentration of alcohol present in the blood.
container will, in any event, be sent to Forensic Science SA where the
"
The results of this analysis will be sent to you at your address
,. 1.4.4„k„ct s presented to you by the medical practitioner [ or registered nurse] who
005^3..0 nurse applies only if the breath analysis was conducted outside
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RegistrYic ON Nat ROISO \KACE
File No CAUSES coOc, H I NG .
DAMAGED ‘1()CAL ccRDS
19q1 1900nTrA
PORT PIRIE
POuce rfiRceriA)0 as follows:
PRese-Mr
P0114
AFFIDAVIT
BETWEEN
POLICE
(NAME OF INFORMANT / COMPLAINANT1
AND
Jacqueline PEARCE
(DEFENDANT) of CRYSTAL BROK POLICE, in the State of South Australia, make oath and say
1.
I am a Brevet Sergeant of Police, identification number , currently stationed at the
Crystal Brook Police Station. I commenced this statement on Monday the 23'd of May
2016.
2.
At about 10.10 p.m. on Thursday the 4th of February 2016, on was on uniform mobile
patrol in company with Senior Constable in a marked police car. At this
time I was sitting in the front passenger seat and we were stopped in the drive-thru at the
McDonalds Restaurant on Main Road, PORT PIRIE, obtaining a meal. Our vehicle was
facing northeast towards Main Road, PORT PIRIE as we drove through the drive-thru.
3.
At this time I heard a female yelling and swearing in a loud voice. The shouting sounded
as if it was nearby, but I could not determine exactly where it was coming from. I was
also unable to hear exactly what the female was saying.
Deponent's Signature:
/1/
4.
Witnessed By: _
Da
^3/ r //6-
(Signature of pe
Strike out whiche pplicable
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LOT 49 4 EUNICE ST PORT PIE SOUTH SA 5540
Account number
Tax invoice
110 000 997 440
Issue date
a
7:7.-.4
12 Oct 16
17M
Nif)
Total amount due
a
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