Victorian Numbered Regulations

CORRECTIONS REGULATIONS 2009 (SR NO 40 OF 2009) - SCHEDULE 5

SCHEDULE 5

FORM 1

Sch. 5

Regulation 86

NOTICE OF VARIATION OF PAROLE ORDER

TO

(Christian Names or Given Names) (Surname in BLOCK letters )

of (Address)

On (Date of Order) you were granted release on a parole order by the Adult Parole Board subject to certain conditions.

The Adult Parole Board has varied a condition of the order/imposed an additional condition to the order/revoked a condition of the order ( Strike out whichever is not applicable ) as follows:

All other conditions of the parole order still apply.

TAKE NOTICE that the order has been varied as above.

Dated this day of 20

For and on behalf of the Adult Parole Board

Member/Secretary of the Adult Parole Board

INSTRUCTIONS

(Office use only)

1.     The signed copy of this Notice to be retained by the Regional Manager.

2.     One copy is to be given to the person on parole.

3.     One copy is to be retained by the Adult Parole Board.

FORM 2

Sch. 5

DECLARATION

I, ( name, in block letters, of person whose parole order is varied ) declare that I have been given an explanation of the variation to the conditions of my parole order and I undertake to comply with it.

Signed     Dated

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