Justice Act - Form 27

Form 27
Justices Act 1886
Section 222
NOTICE OF APPEAL TO A DISTRICT COURT JUDGE
DISTRICT COURT OF QUEENSLAND
REGISTRY: _______________________
NUMBER: _______________________
Between:
______________________________________________________________________
Complainant
And:
______________________________________________________________________
_____________________________________________________________ Defendant
_______________________________________________________________________________ desire to apply
[Name of Complainant / Defendant]
to a District Court judge against the order of
made at
__________________________________________________________
[Insert the name of the Magistrate or the Justice/s of the Peace that made the order]
____________________________
[Insert the place where the order was made]
on
________________________________
[Insert the date the order was made]
The Details of conviction / sentence / order are:
Date of charge:
___ /_____ /_____
Date convicted:
___ /_____ /_____
Date sentenced:
___ /_____ /_____
Offence(s) of which convicted: _________________________________________________________
[Insert the offence name]
Sentence:
Order:
______________________________________________________________________
[Insert the sentence you received]
_________________________________________________________________________
[Insert the terms of the order]
Did you have your driver licence disqualified as a result of this sentence?
Yes
No
[tick the one that applies]
The grounds of my appeal are:
________________________________________________________________________________
[You must set out, briefly and precisely, the grounds or reasons why your appeal should be allowed or what other order you say the Magistrate should have
made]
Version 6 Date: 16 January 2015
My contact details and address for service:
Address of appellant:
__________________________________________________________________________________________
[Insert your residential or business address]
Telephone number of appellant:
_______________________________________________________________________________
[Insert the telephone number of your residential or business address]
Contact information: ____________________________________________________________________________________________
(If you do not have a telephone number you can be contacted at [insert a way you may be contacted])
Facsimile number: ____________________________________________________________________________________________
[Insert your facsimile number (if any)]
Email address:
____________________________________________________________________________________________
[Insert your email address]
Do you wish to be contacted by email?
Name of solicitor:
Yes
No
[tick the one that applies]
__________________________________________________________________________________________
[If a solicitor is appointed to act for the appellant their name and firm (if any) should be inserted here]
Address of solicitor: __________________________________________________________________________________________
Telephone number:
__________________________________________________________________________________________
Facsimile number:
__________________________________________________________________________________________
Email address:
__________________________________________________________________________________________
Do you wish to be contacted by email?
[Insert your email address]
Yes
No
[tick the one that applies]
Note: If you have a solicitor appointed to act for you the address of the place of business for your
solicitor is the address for service. If you do not have a solicitor your business or residential
address is the address for service.
Contact details for Respondent
Name:
__________________________________________________________________________________________________
Address:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
[Insert here the address of the respondent. If the respondent is a police officer you can insert the name of the police station where the
respondent works. If the respondent is an officer of a public sector agency you may insert the name of that public sector agency].
Name/s:
________________________________________________________________________________________
Address:
_________________________________________________________________________
[If there are other persons who may be concerned in upholding the appeal insert their name here. For example, if you are appealing a
compensation or restitution order you should also insert the name/s of the person or persons named in that order.]
_________________________________________________________________________
[Insert here the address of the person named as interested in upholding the appeal].
Do you wish to be present when the Court considers your appeal?
Yes
No
[tick the one that applies]
Version 6 Date: 16 January 2015
Notice to Appellant
1. This notice must be filed in a District Court registry under section 222 of the Justices Act 1886 or the District
Court of Queensland Act 1967. If the District Court registry is more than 50 kilometres from the place where
the order was made then you may give your notice of appeal to the clerk of the court (Magistrates Court)
where the order was made. If you are in custody you may give the notice of appeal to the prison’s general
manager.
2. If this notice is not filed in the District Court registry or given to the clerk of the court or given to the prison’s
general manager within 1 month after the date of the making of the appealed order then you must also
complete form 27B (notice of application for extension of time within which to appeal) and attach it to this
notice.
3. If your address for service or any other contact details change you must file in the District Court registry a
notice stating the new address for service and contact details.
Appellant:
__________________________________________________
Appellant signs here
Date:
_____ / ____ /_____
Place:
__________________________________________________
Version 6 Date: 16 January 2015