Form 6	Small Claims Court—application for variation of determination
Common Boundaries Act 1981
(see s 8 (1) (Variation of determinations))

In the Small Claims Court of the Australian Capital Territory

Application No		of (year) (Court to complete)

(name)
Applicant

(name)
Respondent

To the Registrar:
The applicant applies for a variation of the determination made by the Court on (date) in relation to the *[erection/repair/replacement] of a fence between block (number), section (number), division of (name of division) (the applicant’s land) and block (number), section (number), division of (name of division) (the respondent’s land).
Applicant
Full name:
Address:
(if the applicant is represented by another person)
Representative’s full name:
Representative’s address:
Respondent
Respondent’s name:
Respondent’s address:
Details of variation sought
(set out the details of the variation sought)

Date:

(signature of applicant or applicant’s representative)
(name of applicant or applicant’s representative)