<p> Application to Commence Proceedings for a Summary Offence in the District Court of New South Wales </p><p>Orders sought: An order for the appearance of an accused person</p><p>Act and section under which the application is filed: Criminal Procedure Act 1986, Section 246</p><p>Details of Prosecutor Name: </p><p>Organisation: </p><p>Postal Address: </p><p>Telephone: </p><p>Details of alleged offender Name: </p><p>Address: </p><p>Date of birth or an Australian Company Number (ACN): </p><p>Grounds for application: The person named in this application has committed the offence described in the attached summons, being an offence that can be dealt with summarily before the District Court. A statement as to the alleged facts upon which the Applicant relies is attached.</p><p>Signature of Prosecutor: </p><p>Date: </p><p>Court Registry Use Only Date summons filed: Place of filing: (if different from place application made at) Court reference number: Fees and payment stamp (if not waived): </p><p>Page 1 of 1</p>