BRISBANE CITY COUNCIL ABN 72 002 765 795
Statutory Declaration - Motor Vehicle Oaths Acts 1867
CC11149/1 (30 Oct 2017) © Brisbane City Council - Corporate Forms
If you were NOT in charge of the vehicle at the time of the offence DO NOT pay this infringement notice. Complete the Statutory
Declaration below and return it within 28 days of the notice date. A new infringement notice will be issued to the person you nominate
as the person in charge of the vehicle at the time of the offence
Statutory Declaration Oaths Acts 1867
Do solemnly and sincerely declare that at: on
THE PERSON ‘IN CHARGE’ OF THE VEHICLE, REGISTRATION NUMBER , was;
Particulars of person
This vehicle was sold on (Date) (new owner details must be entered above) OR,
The vehicle was stolen or illegally taken at the time and the matter was reported to
on . Queensland Police Service Crime Report Number
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the
provisions of the Oaths Act 1867.
Taken and declared before me at
Signature of declarant
In the state of
day of 20
1. Person in charge includes the person driving, or responsible for the vehicle, or the new owner of the vehicle.
2. When this notice is served on the registered owner, that person is taken to have committed the offence even though
the person driving may have been someone else. The registered owner may transfer liability to the person in charge of
the vehicle by correctly completing the above Statutory Declaration and returning it within 28 days of the notice date
3. If you are completing the declaration on behalf of a corporation, you must be an Executive Ofﬁcer of that corporation
and nominate your position.
4. This declaration must be witnessed by a Justice of the Peace, Commissioner of Declarations, lawyer, notary public or
another person authorised to administer an oath under the Oaths Act 1867.
Return this Statutory Declaration within 28 days of the infringement notice date to:
Brisbane City Council
GPO Box 1434
BRISBANE QLD 4001
DO NOT SEND PAYMENT WITH THIS DECLARATION - A NEW NOTICE WILL BE ISSUED TO THE PERSON NOMINATED.
This declaration must be witnessed by a Justice of the Peace, Commissioner for Declarations, lawyer, notary public or another person
authorised to administer an oath under the Oaths Act 1867.
Date of birth Licence number (if known)
Residential address Postcode
This Statutory Declaration pertains to:
Infringement notice number
Vehicle registration number
Signature of authorised witness