EFTA00265337

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Form 1 
COMPLAINT 
Magistrates Court of South Australia 
www.courts.a.gov.au 
Summary Procedure Act, 1921 
Section 49 
Complainant 
Name:  the undersigned a member of South Australia Police 
Address: PORT PIRIE PROSECUTION UNIT 
18 MAIN ROAD, PORT PIRIE SA 5540 
Defenda 
Name: 
Surname 
Address: I 
t 
Court Use 
Date Flied 
anrs Reference 
WI
I a 
DOB: 
Given Name 
Strew 
Crly / Town I Suburb 
State 
Postcode 
DDIMMIYYYY 
Licence Number 
Offence details 
1. On the 13th day of AUGUST 2015 at PORT PIRIE in the said State, 
drove a vehicle namely a maroon MITSUBISHI sedan SA Registration 
Pirie Island without due care 
Section 45 of the Road Traffic Act 1961. 
This is a summary offence. 
2. On the 13th day of AUGUST 2015 at PORT PIRIE in the said State, 
being a person to whom a direction was given to provide personal details pursuant to Section 40V(2) 
or 40V(3) of the Road Traffic Act 1961 by a member of the Police Force or authorised officer did not 
comply with such direction by engaging in conduct resulting in a contravention of the direction. 
Section 40V(4) of the Road Traffic Act 1961. 
This is a summary offence. 
3. On the 13th day of AUGUST 2015 at PORT PIRIE in the said State, 
Resisted Constable Scott KELLY a member of the Police Force in the execution of his duty. 
Section 6(2) of the Summary Offences Act 1953. 
This isa summary offence. 
4. On the 13th day of AUGUST 2015 at PORT PIRIE in the said State, 
being a person who was required under Section 47E of the Road Traffic Act 1961, to submit to an 
alcotest, refused to comply with all reasonable directions of a member of the Police Force in relation 
to the requirement 
Section 47E (3) of the Road Traffic Act 1961. 
This is a summary offence. 
on road namely John 
• 
Other orders sought (forfeiture, compensation, additional penalty, destruction or the like — Rule 15.03) 
EFTA00265377

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ALCOTEST 
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BOOTH AUSTRALIA POLICE DEPARTMENT 
POLICE APPREHENSION REPORT 
AP No 
16/846998 
Report Job Submitted By I.D.: 7431/3 
Run Date 
Run Time 
Page 
26/08/2015 
: 15:01 
1 
2 
JACOBS states that at about 8:30 pm on Thursday 13th August 2015 she was about 
50 metres away from the Jetty at a place known to the PORT PIRIE locals as "The 
Bridge to nowhere". JACOBS was with friends doingsi 
bi!
tography when she o 
erved a maroon MITSUBISHI sedan, SA Registration 
driving towards her 
and the group she was with. 
JACOBS watched as the sedan drove towards them at speed. JACOBS didn't know what 
speed it was travelling at but thought it was going so fast it was going to hit 
her and the group. 
JACOBS states that the car braked heavily and turned, stopping about ten (10) 
metres away from her. The car was being driven in a very erratic manner. 
JACOBS observed that the driver of the sedan wan a female, wearing a blue dress 
with high heels and blonde hair and that she was the only occupant Of the 
vehicle. JACOBS Saw that she exited from the driver's seat. 
JACOBS further states that she could hoar the female talking but could not see 
anyone else with her, she wasn't sure if the female was talking to herself or 
not. 
POLita 
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NA EAR 5/N‘f 
At about 9:07 pm on Thursday 17th August 1015, Police KELLY was on mobile 
uniform patrol when tasked to a Driver Under the Influence  in an area of PORT 
Plan known as °The Bridge to Nowhere* on the John Pirie Island. The tau 
for a drunk female driving a maroon MITSUBISHI Magna, SA Registration 
and that the driver bad almost been involved in an accident. 
On arrival Police KELLY in a marked police vehicle located the motor vehicle in 
question, • maroon mITSUHISHI sedan, SA Registration 
on the beach front about 50 metres away from the Jetty area. 
krd
KELLY observed a female seated in the driver's seat of the sedan and exit the
vehicle to be standing next to the driver's door on KELLY emitting his valicla. 
0' 
KELLY approached the female who was veering a blue dress and  
/high heels" 
u")
attempting to roll a cigarette. 
ON 
;\K:1 P>
KELLY activated his personal body worn camera and approached the female holding 
an Alcotest device in his band. The female immediately told KELLY, "I'm not 
blowing into that'. KELLY could immediately smell a strong small of intoxisa 
liquor coming from the female. 
.The female started to walk around the car away from
 who could see 
was unsteady on her feet. KELLY asked the female if she was the driver 
otor vehicle, her response was that she found it. 
parked facing north 
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EFTA00265378

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Page 2 of 3 
Continuance of AFFIDAVIT of: 
Scott KELLY 
6. 
I turned the vehicle off which turned off the music in the car. I secured the keys that were 
located in the ignition to my key clip on my work belt. The key was a single MITSUBISHI 
car key with a black tag attached. 
7. 
At the time of her arrest,
iwas holding in her hand a can of "Wild Turkey" 
bourbon and a cigarettea 
smelt strongly of intoxicating liquor during my dealings 
with her. 
8. 
A bag was located inside the vehicle which was conveyed with 
to the Port Pirie 
Police Station. 
9. 
At the Port Pirie Pollee Station, 
identified herself as 
to the charging Sergeant, Sergeant Jayne MILDRUM. 
MME 
10. 
a 
refused to submit to an Alcotest. She was issued with a twelve month instant 
loss of licence which she refused to sign. The keys that were taken from the ignition of 
her vehicle were booked into.her property and returned to her on being bailed. All the 
property that was booked onto the SHIELD property section was signed for as belonging 
: ton 
by 
. This included the contents of the bag that was removed from 
the vehicle and the car key. 
Deponent's Signature:  
t; 4P 
 Witnessed By: 
(Signature of person before whom affidavit affirmed and 
Date:  
/ 
/ Le, 
declared) 
* Strike out whichever is Inapplicable 
Revised: 2411/2015 
EFTA00265379

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EXITED 
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~RtJCRS 
IN THE MAGISTRATES COURT 
BETWEEN 
OF SOUTH AUSTRALIA AT 
POLICE 
• PORT PIRIE 
(NAME OF INFORMANT / COMPLAINANT') 
AND 
AFFIDAVIT 
(DEFENDANT) 
I, Ernie POLLEY of CRYSTAL BROOK, in the State of South Australia, affirm and declare as follows: 
1. 
I am providing this statement to Constable Scott KELLY of the Yorke Mid Highway Patrol 
per phone. 
2. 
I provided this addendum statement on Thursday 11th of August 2016. 
3. 
While I was doing my photography with a group of friends over °The Bridge to Nowhere" 
in Port Pirie, I observed a vehicle come up to us at speed then skid to a stop. I was 
worried that the car was going to crash into us. I went up and spoke with the driver. It 
was a female and she was alone in the vehicle. 
4. .t)frShe exited the vehicle  and it appeared as though she was having a one person party. 
She was lounging on the bonnet of the vehicle and dancing around. 
5. 
One of the group contacted police and when they came, they arrested her. It was the 
same woman that was driving that was arrested by police. 
Deponent's Signature: 
Date:  17 1 
//‘:7 
Witnessed By: 
(Signature of person before 
affirmed and 
declared) 
'I Strike out whichever Is inapplicable 
Revised: 24/112015 
EFTA00265380

Nm IN A Vert icte" oR KEYS t (NI PoSses5teA TO opcRerre.
A vet( cce - gerdsp.c. o F Ac_cerre.S-t--
FULL NAME: 
ROAD TRAFFIC ACT - ALCO TEST FOR ALCOHOL 
ORAL ADVICE ON REFUSAL OR FAILURE TO COMPLY 
Pursuant to Section 7E(4Xab) of th Roa
Oda
 
T ffIc ct, 1961 
I said: 
Subject said: 
I said: 
Subject said: 
NOTES: 
I said: 
Subject said: 
I said: 
Subject said: 
I said: 
Subject said: 
I said: 
Subject said: 
I said: 
Subject said: 
I said: 
Subject said: 
I said: 
Subject said: 
RO201 
'It is 
is a criminal offence to refuse or fail to provide a breath sample without good cause. You could be fined 
and lose your licence for 12 months or more. It is a defence if you have some physical or medical condition that 
prevents you from providing a breath sample, but only if you ask for a sample of your blood to be taken instead, 
or can show that your condition also prevents the taking of blood. If you want a blood sample taken because 
of your condition, you should asE for that and the police will help you to have the sample taken at Government 
expense. Do you understand? ' 
1 now give you a final opportunity to shit to an alcotest. I again direct you to take a deep breath and to seal 
your lips around the mouthpiece and exhale continuously through this mouthpiece, into the alcometer instrument 
with one continuous breath until I tell you to stop. Do you understand? 
• 
 
e.--rt-draiSeA> 
SUBJECT: 0 COMPLIED 
/ 
‘USED 1 0 FAILED TO COMPLY (If so, how?) 
1 am going to ask you some further questions concerning this matter. You are not obliged to answer these 
questions unless you wish to do so. Anything you do say may be given in evidence. Do you understand? 
love nu any reason for. refusin or fal7Fn Zi:omply with
'
 m,direction i 
•
5 . i(s--3/4\thet-zs 
rectspit. 1/451 
'Have you any reason of a physical or medical nature for refusing or falling 
to this alcotest? 
•  I 
CIANWCI 
 e r 
"You will be reported for refusing or failing to comply with my directions in relation to this test 
Do you 
understand? 
•  t victry  ot 
don to su‘i2r c nrg to this alcotes 
in "kg_ car. 
It is a defence to a charge of refusing or failing to comply with my direction to submit to an alcotest if the reason 
for your refusal or failure to comply Is because of some physical or medical condition. You cannot use such 
a defence unless you immediately make a request that a sample of your blood be taken by a medical practitioner 
nominated by you. However, if it becomes apparent that there is no reasonable likelihood that the medical 
practitioner nominated by you will be available to take the sample within 1 hour at some place not more than 
10 kilometres from this location, or you do not nominate a particular medical practitioner, the sample of blood may 
be taken by any medical practitioner who is available to take the sample. Do you request that a sample of your 
blood be taken? 
•  
f•-_10 4 I wati•-i- ot I a,w4 er 
"Which medical practitioner do you nominate? 
"Arrangements will be made for a blood sample to be taken from you. Do you understand? 
SUBJECTS SIGNATURE: 
REPORTI
BER 
rNG MEM
_s_3_06-2/t 
Rent  
Le /VS 
 
Posting: 
Time: 2t S Srs  
Date:  /31 s /5  Signature: 
Name: 
DISTRIBUTION: ATTACH TO REPORT DOCUMENTATION 
Rev:sed 1/07/2013 
Page 1 a I 
Government 
of South Australia 
EFTA00265381

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:this 
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EFTA00265382

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Ext._ -eSS t ve aRk...)-nch.A 
Patient Name: 
Patient Address: 
D.0.6: 
Medicare No.: 
Lab. Reference: 
Addressee: 
M KAJANI 
Date Requested: 1 '0/2015 
Date Collected: 
Specimen' 
7)(Subjecterest Name 
Dr Abdul F. 
Pirie Me0'. 
45 Gertr 
2J KAJANI 
. Centre 
:street PORT 
tedicus.net 
:1-1 
Performed at: PORT PIRIE 
Exam: 2nd October 2015 
PIRIE 5540 
Sex: F 
I No.: 
Provider. PERRETT MEDICAL IMAGING 
GROUP 
Referred by: 
Dr A KAJANI 
to Perform 
2)101201;-%\ 
Complete 
XRP 
iT SHOULDER 
.al Details: Painful. Alleged injury 13/09. 
rt: No fracture or bony malalignment.*There are mild degenerative changes 
:he acromioclavicular joint. 
r Michelle Reintals 
electronically signed Fri 02/10/2015 2:50 pm 
NMT/pt 
Accession: 10884657 
EFTA00265383

'Form 79 
„domkg:e-k.)51 1G AN ALc_o -FEST - 
t HMOBlc.t 2ATicjt >fr 
<Er 
APPLICATION FOR REVIEW OF LICENCE 
DISQUALIFICATION/SUSPENSION 
Magistrates Court of South Australia 
r citicict'srasrc _Act 1961 - Section 47IAB 
Registry 
? 
whiAh , Application 
is 
made 
i 4_ 
File No 
Party details 
Applicant 
Name- 
sumain 
Address 
sty 
cit 
Respondent 
Name 
South Australian Police, 
Address ....erAT....P.INAF; 
se
Disqualification Notice Number 
Brief number 
On the 
day of 
C 
 2016 a member of the South Australian Police issued and handed a 
Notice of Disqualification/Suspension pursuant to Section 47lAA of the Road Traffic Act 1961, commencing on 
 
ziczit., to me. (copy of notice attached) 
I apply to the Magistrates Court for the following order. 
A 
That I am not Disqualified/Suspended as there is a reasonable prospect that I would be acquitted of the offence. 
47IAB(2)(a) RTA) 
0 
That the Disqualification/Suspension be reduced as the offence is a first offence and was trifling. (s 47IAB(2)(b)(I) RTA) 
0 
That the Disqualification/Suspension be reduced as there is a reasonable prospect that I would be acquitted of a 
Category 3 offence but may be guilty of a Category 2 offence. (S 47lAB(2)(b)(ii) RTA) 
The grounds for the application and the evidence that will be relied upon are: (copies of documents attached) 
0 
Blood Test — Blood taken at  
am/pm on the .... day of 200.... Blood Test Result 
% 
0 
Opinion of Doctor  
(Doctors Name) dated 
 day of  
 20....
9, 
Other :- give details 
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any offence which 
disqualification/suspension served on me 
I have/have not also received a notice from the Registrar of Motor Vehicles containing particulars of my licence 
disqualification/suspension. 
Applicants signature 
I understand that if I rive w i st isqualified/suspended I may be imprisoned.(s 91(5) mvA) 
Hearing date 
&V 
"k W( 
Registry PP,1- 
ff‘/C.  
 
Date Ifr.1  htie
Address 
 
 
acct. Ii0e1s, 
 
Time 
am/pet 
telephone 
date 
facsimile 
e-mail address 
COURT 
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EFTA00265384

CI<RCINITED ZeseD c") THE APPLAcercrot 
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CERTIFICATE OF RECORD 
Court of Origin 
MAGISTRATES COURT OF SOUTH AUSTRALIA 
Registry Address 
20 Main Road, PORT PIRIE. SA 5540 
Phone Number 
(08) 8638 4901 
Court File Number 
MCPIR-16-1376 
Originating Document Type 
APPLICATION FOR REVIEW OF LICENCE DISQUAL/SUSPENSION 
Particulars of Applicant 
Name 
Date of birth 
Address 
Details of Offence 
(as specified in the document annexed hereto) 
I. the undersigned. Registrar of the MAGISTRATES COURT OF SOUTH AUSTRALIA. an officer haviiiiitody 
of the records of the said court. DO HEREBY CERTIFY that the abovementioned 
was 
dealt with as follows:-
13/07/16 10:00am 
•: . C 
OURT OF SA PORT PIRIE 
Presiding Officer Magistrate K.A. MILLA 
For Prosecution: N 
DEFENDANT APPEARS 
Via AVL 
1 Application For Order lb Lift Licence D.  ualification 
PLEA: NO PLEA APPLICABLE 
Evidence taken - PAD1- K 
4 His Honor orders that th 
removed pending the outco 
substantive char: 
15-1712). 
DATED this 14th day of July, 2016. 
PROSECUTION VIA AVL 
Registrar 
ce1075 
14/7/2016 12.13pm 
EFTA00265385

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of South Australia 
Notice issued: 15-11-2017 
ltppuldhluminttllittlllttut 
5554 
Notice of fine 
eta•asat f55) 
Amount due 
Please pay by 
Fine reference 
Payment reference 
58454730450 
e Yaw fins is neyrible to the Fines Enforcement and 
Re .every Officer. S'e payment options below. 
% 
o`t 
13-^8-20-5 
Total amount due 
9840.03 
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Your payment options 
Internet 
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va.A....thas.sa.gay.au 
carats at: 
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Direct Debit 
1800 659 538 
wyer.fines.sa.gov.au 
Visit www.flnes.sa.govau for 'core ignat:On on payment colons. 
(110 BPAY
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EFTA00265387

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Government of South Australia 
-•;•;. 
Fines Enforcement and Recovery Unit 
nsaticn / restart 
3rd party COsts: 
Offence rriaity / fine: 
Fees / costs / Cnarges: 
TOTAL 
Less amc.int teemed. 
S389.50 
S1,a89.50 
8649.46 
SB40.04 
lines.sa.gov.au 
1800 059 533 
- I u-Cc4 e 
EgiwoOLENT 
Conditions of your payment arrangement 
Subject to sibctaise 2. if 
fail D3 rake a payment due stir nis arrangement tnen is enen2sment will terminate upcn 4 days after rya data on 
vinyl tie Darrell was die (unless vet payment is received dring het Pete,. 
2. 
rue ICJ re paymg by Direct Debit (in axo-da-ce ./myor Direct Debit Senitekreenelf) if
 is resod die to Inisficiant Lrcts being 
~liable. he date ten hat payment is extended 
the date al viler, he next pare-tie due inde' the ariangement reatension date'). If at hat 
date payment is not temieved by the extension date tie arrange-rant rei tear:rate 401 14 days arts- he extension date (✓iess that payment is 
reeked dring that peeled). 
3. 
If ye.: amer.gement á s.ibjed tc an ago-co:on deteminaten a- administrative wc..iplrg at) tfie Wrangrr ant tennflaa)S. the aggregation 
determiners-I or admitative ers'ng r,Si be revoked and ewe] incriVd-el asp or nerd ved become payable. 
4. 
If 
arre 
rit term: ales. enfccement actien may be talen and fees apad. 
Detail of offences related to this notice 
Fine tierce  
DescrIptIon of offence 
Due ewe • Baec C4lesce 
Drive With Excess &cod Alcohol 
Other payment options 
Date Cl effe-te 
13-08-2015 
19-05-2015 
Visit fines.se.gov.au for more information on payment options. 
Contrapay 
Direct Debit 
1800 659 538 
1800 659 538 
myfires.sa.9.0vad 
rriyfices.se.govieu 
Post 
Complete If PaYin2 by Visa c-• Itilastertat. 
Cnee..esirdcney OTice avid be made c.it te he 
"Fines Enforcement and Recovery Officer. 
Pest with this sap to PO Box 283, Ranee Vat SA 5000 
Details of fine 
I 
/1 232 17915C3103eneue 22 
Post 
Use the Australia Post 
Bitipay 
App or pay in-store 
Ceti type 
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O MesterCat 
Name en cat  
Cat number 
Cat expliy 
Sig-et-re 
Date 
 
 Arrant $ 
TnIa Part ]: a"algemoni lea been ec-iced ten: ^ accetricri wan eitner secien 
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Excierion of °%b-cas Act 1996 (SA). 
'Leas ame.int. teCced 
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EFTA00265388

Government of South Australia 
r its 
`APC.2-1 CE 
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% DRIVER LICENCE REPORT 
frner41 
crick-i- SUMMARY OF OFFENCES AND DISQUALIFICATIONS RECORDED 
lie -At? (\C 5 
. 
IN THE REGISTER OF DRIVERS' LICENCES 
This record is a true and correct extract from the register of Drivers' Licences based on our records at the time / date indicated on the report. 
AcaorrrE0 o 
c HlehS66S 
K . A . tat iw,RD _ I.J127ED SOSPENSttmi CA3 
ce N CC - &kr I A) ueHIaE 
Department of Planning, 
Transport and Infrastructure 
4 -2-___LcEce L KauRb 
- i LcEte L- Loss or D€4EfJi T POINTS 
acAS 
(-) rC C CAN 
- --r-ASka›. TO AREA 
RECENEOS20.00 M S3012 190701 
Licence/Client No 
Surname 
Given Name 
Residential Address 
Date of Birth 
Year or Date Of Issue 
Current Licence Commenced 
n.I 
1/41 t-riv 
--I €57( not%) 
ki
ES
1986 (Year of Issue is Estimated) 
25407/2014 
Licence Details as at 301121201910:38 
Type 
Full 
Car 
Class 
Car 
Status 
Expiry 
Conditions 
Active 
24/07/2020 
Active Demerit 
Points* 
0 
My motor vehicle with a GVM not exceeding 4.5 tonnes (except a bus designed to carry more than 12 seated persons and a 
motor bike or motor bike). 
'Active demerit points are calculated at the time of enquVy but this may be amended If other offences are subsequently notified to the 
Registrar of Motor vehicles. 
This document confirms that the above named person holds, or has held, a Drivers Licence In South Australia, and IS NOT, In Itself, AN 
AUTHORITY TO DRIVE. 
Offence and Disqualification details: 
Offences (*Active Demerit Point offences) 
Description 
__ 
 
Demerit Points 
Detalls(if known) 
F 13/08/2015 
Driving without due care or attention. etc. 
3 
19
11:102,2414 
MAN 
_____ abancimmisolevh
5/20 
whilst having 
concentra 
alcohol be blood less than .08 4 
ncentration of alcohol in blood. less than .08. 4 
0.05 
slopped by a mobile RBT) 
22/12/2007 
Driving with prescribed concentration of alcohol in blood - 0.08 gins to less than 5 
0.139 
0.15 gms of alcohol In 100 me of blood 
19/05/2007 
Exceed Signed Speed by up to 14 kph 
1 
08/04/2007 
Exceed Default Speed in Built Up Area By Up TO 14 Kph 
1 
Disqualifications 
Disqual No. 
Disqualification Type 
1 
Court 
*Licence Suspensions 
Act 
RTA 
478 
Section 
From 
11/03/2008 
Until 
24/07/2008 
Reason 
Immediate Alcohol 
* 
Immediate A10:601 
From Date 
24/12/2007 
13/08/2015 
Until Date 
10/03/2008 
12/07/2016 
30/12/2019 10:38:34 F00465 12280878908 
1 of 2 
EFTA00265389

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Form 1 
COMPLAINT 
Magistrates Court of South Austrt 
www.courts.sa.gov.au 
Summary Procedure Act, 1921 
9-R4€-FRAL 
Section 49 
T 
Court Use 
Date Filed 
Complainant 
THE UNDERSIGNED A MEMBER OF SOUTH 
Name: AUSTRALIA POLICE 
Address 
Address: 
PORT PIT PROSECUTION UNIT 
18 MAIN ROAD, PORT PIRIE SA 5540 
16/T64108 
Disqualification Reference 
08 8638 4032 
Telephone 
Offence details 
1. 
On Thursday the 4'h day of Februa 2016' t 
behaved in a disorderly manner in a public plac , name 
Section 7(1)(a) of the Summary Offences Act 1953. 
This is a summary offence 
2. 
On Thursday the 4th day of Februar 
ORT PIRI in the said State, 
---...i
resisted Gary BROCKHOUSE a member of the police force in t e execution of his duty. 
Section 6(2) of the Summary Offences Act 1953. 
This is a summary offence 
the said State, 
Other'orders sought (forfeiture, compensation, additional penalty, destruction or the like — Rule 15.03) 
Date 
Complainant 
Witness 
(Registrar, Deputy Registrar or Justice of the Peace) 
(Not required if Complainant is a Public Authority) 
EFTA00265390

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POIIcc BRUTALITY — 1 t•), CRIc5.5 SOST14 I NE.,-E) EKTREM E I 
PD114 
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Page 3 of 3 
Continuance of AFFIDAVIT of: 
Gary Jeffery BROCKHOUSE 
10. 
The accused lashed her legs around, I saw one leg clip the leg of BOWMAN. The 
accused was eventually handcuffed to the rear, placed into the rear of the police fleet. 
The accused was conveyed to the Port Pirie Police Station and advised of her arrest 
rights. 
11. 
The accused was charged with disorderly behaviour and resist arrest. 
12. 
The accused appeared to be either under the influence of alcohol or drugs,  or suffer from 
possible mental health issues  ue to her erratic and bizarre temperament whilst in police 
custody. 
13. 
I have had no further dealings in the matter. 
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*.SAAFeRfercr I AFFIRMED AND DECLARED AT 
by the above named deponent, this  
I le 
day of  
GNATURE OF DEPONENT) 
20 
Before me: 
Proclaimed Police Officer 
0 Justice of the Peace 
(Signatu of person before whom 
affidavit 'sworn / affirmed and declared)  0 Other: (Specify) 
PI TegSeti
(Name) 
elli Signing IC) 
PPPS 
(Station / Suburb) 
Revised: 24/11/2015 
EFTA00265391

RESOCT or 
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St.1415.0411 (P;00 2 04) 
eiteSCRi 
Belt) 
d. 
Centrelink 
Medical  Certificat 
.4ustratian Govertnlecnt 
Office use only 
Customer CRN 
Patient's Details 
surname 
Given Names 
Date of Birth 111.1 
Horne address 
C 
Your personal infonnationnprote:Md by law Tb4 Si:th0,4 to mTed thh anformetson ie contepted in II 
Serial Sec 'y (ildrnn,:fraMe) Ad 19A 010 rifoirowbon prmicl dd1 IRIS fpm ad b used to decide 
terra" Nyman's and seniCatt For you and where roleyant, third partM1 For Me Plitpalas of Sacral for 
'parameter anastance. Centelink may ire your information to Coma* cOntractect Seamark the 
Dedinamsre of Erialoyment end Workplace Reis:ions (OEWR) aid JO NINO* members or swab 
perasee waling an Man' mum to M Deparoneed of Farr* and Coneurgy Sontag (MaDS) and their 
bided sank:etc to the Depertnere of Health and Arming (Omer) And Its RAMS 'antes; and to the 
Oepairemmt of &Meador% Science and Training WEST) and their funclea services. 
Authority NM asa medical Informetton 
. I aulharia• Cella* 10 Seem n rein" minced lMOTWOCM raCeesary to (Wide my gook/imam 
for 
alloaanot Persian aid eleaDittly to assistance from my elsaix(s), a dna regleterect medical 
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relevant banieta impeding al my ability to partkiptae in snares panne With my beeline tiodor(s) 
end arty cite tteenta professarate I may twee emanated. a torte I ter be taloned by Control,* In 
order for Caremark to decklecorrect peretnenta oral Wen Motes end program for myself. and where 
relarent. tiled Pante& 
Patient Signature 
and date 
/ 
/ 
)(c- 
Dia nosis- Pleas li 
'ons (illness, injury or disabilinr) which impact on your patient's capacity for work or study. 
2 
3 
S con Mon is
MAY CONTINUE 
Date of onset (if known) 
Mre 
Uncertain 
November 201 
s of the condition) 
Fitness for work/study 
In my opinion this person is/has been unfit for work/study 
km3/11/2015 
to 3.'112016 inclusive. 
Can the patient currently do their usual 
work/study? 
Can the patient do any other work for 8 
hours or more per week? 
No 
No 
In order to prepare your patient for return to worWstudy, 
certain assistance may be offered. Please identify any 
factors which may impact on participation, 
Treatment - Please describe the patient's treatment 
e ime 
Certification by Medical Practitioner 
This person has been: 
My patient since  
A patient of this practice since  
Doctor's printed name 
X  Dr. A. M. KalanI 
Qualifications  
MBBS, FACRRM, MCPS 
I Provider no. I 
0962826X 
Surgery/Medical 
Pine Medical Centre 
Centre/Hospital name 
Street Address 
Telephone 
Doctor's signature 
If this form 
caner than 20 employees. please provide an 
hours 
estimate of the erne taken so conmeete this tom 
45 Gertrude Street 
Port Pirie SA 5540 
(08) 8633 2544 
minutes 
EFTA00265392

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Centrelink 
Medical Certificate 
Ote use only 
Cusbmer CRN 
Patient's Details 
Summe 
Given Names 
Date of Birth 
HOM. address 
Your personal intonnotion is ~ned by kn. "na avtalt/ lo nobel bis Information Is cannot] In Me 
Social Seculty (Adrf driadercn) Ad 1999. Ibia infonnann grann on tds tonn will be tamd to noido 
cmnaci banan and unen kr nu arb anm Seira" tard partiaa For in bunns« ot ner* fot 
appyciadale ~anm Genitalia møy gny your Incemalion ta Gnelt corilrectad assamon the 
Dipanmant ot Enbilorionl and ~press Ftelakna (DEVIIII) and ~Nabb« merren ar «Mos 
annars worldnb on exa bandt b be Deperenent d Farta anti Gaum* Sann« (FiCS) and bar 
hannal anna lo ha Departnitird of ~ib and Agang (Dobb orid bar Innb Garna; and b ti» 
Department of. Editerer" Sclena. and Tråling (DE Sl) and thar Mnd urner. 
Autbarity to røme marlatl infamation 
• I IlitilOOS. CenaelMa to reima any Sann medcal ~motion necesaary to dadda my qualifbation 
for 
allowarca perielon and *bia 
tar naislanca from my doctor(s), a can registarad ~bai 
praclitionars ~Vor Men aolesaingiels ~minna C0neraed. Or lo vitamin« bs rormad by 
~akk 
• I onani lo ~link 
exnanginj nertevan1 irtn‘sbon SJOA My ~dal 0nligien ard ang orar 
namn barna mpaceirm on my abilIty b panicipate In asaleaene programs Mai my baling doctor(s) 
ard any altar health attan:bala I may nava ~bad. or b abo I may bo reremm by ~na 
in 
order tix Gnr** ko ncide ~ed paynrenta and subba anna an programs br mysa, and anere 
mers« Mad partia 
Patient Signature 
and date 
tøs) 
I 
I 
Diaanosis- Please list all 
ical conditions (Illness, injury or disability) which impact on your patient's capacity for work or study. 
2 
tus condition is 
Prognosls — Symptoms are: 
toms of the condition) 
Uncertain 
Fitness for work/study 
In my opinion this person is/has been unfit for work/study 
from19/1/2016to 19/3/2016 inclusiye. 
Can the patient currently do (hair usual 
work/study? 
Can the patient do any other work for 8 
hours or more per week? 
Certification by Medical Practitioner 
This person has been: 
My patient since 
A patient of Ibis practice since 
No 
Doctots pdnted name 
)‘  
M. Kaiaret 
Qualifications i 
raa, FACRRM, MCPS 
Provider no. I 
0982828X 
No 
Surgery/Medical 
Centre/Hospital name 
In order to prepare your patient for return to work/study, 
certain assistance may be offered. Please identify any 
factors which may impact on participation. 
Treatmeat - Please destribe the patient's treatment 
regime. Intude past, current and planned treatment. 
Street Address 
Telephone 
Dodor's signature 
Piria Medical Centre 
by e burJness wilh 
teser eten 20 employees, please 'nitide an 
estimat* of the ame teken to complele tiis form 
tipurs 
minutes 
EFTA00265393

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WAS NOT PReser•IT 
.1 co tQL)ecr Ea TO PP Ot. GARDNCR ONE) M1CHAEL FETHEPSU-NHALti 
Registry PAM I C-/ CC.NN Ecrg: 
SES CA L. "T F)iaGieT( NZ4 
File No 
IN THE MAGISTRATES COURT 
OF SOUTH AUSTRALIA AT 
PORT PIRIE 
PD114 
-ri-lac-e-rs or ccuegN)Niel\ir 
PkoStrro -T tot) 
AFFIDAVIT 
BETWEEN 
POLICE 
(NAME OF INFORMANT / COMPLAINANT") 
AND 
INN 
(DEFENDANT) 
N of CRYSTAL BROOK, in the State of South Australia, affirm and declare as follows: 
1. 
I am a Senior Constable of Police, ID 72923, currently stationed at CRYSTAL BROOK 
Police Station. 
2. 
I commenced this statement at about 6.15pm on Sunday the 22nd of May 2016. 
3. 
At about 10.10pm on Thursday the 4 th of February 2016, I was in company with Brevet 
Sergeant Daniel NICHOLSON, obtaining a meal at the drive through at MCDONALDS, 
located on Main Road PORT PIRIE. 
It was at this time I heard a female yelling and screaming, I couldn't make out what she 
.was saying. 
5. 
As I drove from the drive through I could hear and now see a female walking in a 
northerly direction along Main Road, she was yelling out 'you fucking dogs'. It was at this . 
time that I observed and Senior Constable Earned MUHSIN following the female on foot. 
6. 
A short time later I observed Constable Gary BROCKHOUSE drive his police fleet into 
the carpark of MCDONALDS. I parked my police fleet near BROCKHOUSE'S as I 
observed MUHSIN and BROCKHOUSE struggling with the female. I assisted in 
controlling the female while she was handcuffed. 
Deponent's Signature: 
Date: 2-S 
' Strike out whichever is inappli 
Witnessed By: 
,.•
(Signature of pO son 
Pore whom affidavit affirmed and 
declared) 
Revised: 24/11/2015 
EFTA00265394

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Sworn at Par+ IP; I-IN-C.- 
in the said State 
: this lI 14—day of 
Nessrev.4.1e.(2NP as,  16,
before me; 
idifhts , 
of the Peace) /Z eta* 
Lees - 
EFTA00265395

4-0.)QuQ‘E.5 - PC-Rmn-Ne.4\11- - 2015 
9_020 - 
pi-resiceL - foci cC 
. 
Ci4Cicit 
Patient Name: 
Patient Address: 
D.O.E: 
Medicare No.: 
Lab. Reference: 
Addressee: DR/ M KAJANI 
Date Requested: 
Date Collected: 
Specimen.
Sublect(Test Namv). . 
:?•0/2015 
510/2015 
Dr Abdul Y 
Pirie Mee.
45 Gertr . 
piriemc. 
Sex: F 
I No.: 
Provider: PERRETT MEDICAL IMAGING 
GROUP 
Referred by: Dr A KAJANI 
4r Date Performed: 2/10/2015 
Complete: 
KAJANI Performed at: PORT PIRIE 
. Centre 
EX8m: 2nd October 2015 
street PORT PIRIE 5540 
Tedicus.net 
XRP' 
it SHOULDER 
Details: Painful. Alleged injury 13/09. 
r Michelle Reintals 
:lectronically signed Fri 02/10/2015 2:50 pm 
HMT/pt 
Accession: 10884657 
EFTA00265396