Form 74AK Supreme Court [or Form 147 District Court]

Supreme Court Rules P. 75. 3H (1) [or District Court Rules Part 53 Rule 10B]

ELECTION UNDER S. 132 (5) OF THE CRIMINAL PROCEDURE ACT 1986

REGINA v FRED BLOGGS

I, FRED BLOGGS, of 67A Johnston Street, Annandale, having previously elected to be tried by a Judge alone in respect of these proceedings, now elect to be tried by a jury.

The date fixed for my trial is 1 April 2002.

Dated: 30 March 2002

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Accused

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Witness to signature of accused
Full name and address of witness: