Online Form - Infringement Appeal Form

If you wish to dispute a fine, you must submit an appeal in writing and return it to the Town by:

Email: town@cottesloe.wa.gov.au
Post: Chief Executive Officer, Town of Cottesloe, PO Box 606, Cottesloe, 6911
Completing the form below

Appeals cannot be received over the phone.

Please ensure that you have read the information provided on the 'Appeals' page of what constitutes a valid appeal.

If the appeal is submitted correctly, a confirmation message will appear on your screen and an appeal acknowledgment letter will be sent to your provided property address within 10 business days. If you do not receive an acknowledgement of your appeal, please contact the Town on 9285 5000.

Name of driver *

Residential address of driver *

Postal address of driver *

Date of Birth of Driver *

Phone number *

Email address *

Car registration number *

Are you the owner of the vehicle? *

YesNo

If no, please provide car owners details (name and postal address)

Infringement number *

Date of infringement *

Location of infringment *

Please enter the details of your appeal *

Supporting Evidence

I declare that the above information is, to the best of my knowledge, true and correct. I understand that it is an offence to give a false statement or one which is intended to mislead.

Yes

Signature *

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