ABSTRACT

INFORMATION has this day been laid before the undersigned by] [on behalf of ] [Council, that you

on ]>var5<[

at ]>var6<[

Did dishonestly and with a view to gain for himself/another with intent to cause loss to another falsified for accounting purposes a document namely a............................................... form by making therein an entry which was misleading, false or deceptive in a material particular in that................................................... contrary to s 17(1)(a) of the Theft Act 1968.

YOU ARE THEREFORE SUMMONED to appear before the Magistrates’ Court