Litter Act 1979
Miscellaneous provisions
Schedule : Form of infringement notice
"Notice of breaking litter rules: a repealed law document"

The Litter Act 1979 has a part called the Form of infringement notice. This notice is connected to section 14(4) of the act, which you can find by following the link to s 14(4). The Form of infringement notice is actually no longer used, as it has been repealed.
You can tell it is no longer used because it says "Repealed" next to its name.
When something is repealed, it means it is no longer part of the law.
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View the original legislation for this page at https://legislation.govt.nz/act/public/1986/0120/latest/link.aspx?id=DLM33492.
22: Repeals, revocations, and amendment, or
"Changes to old litter laws: what's repealed, revoked, or updated"