Common Boundaries Act 1981—Form 5
(see s 6 (5))

In the Small Claims Court,
(Name of applicant)
Applicant
(Name of respondent)
Respondent
Application under the Common Boundaries Act 1981, section 6 (5)
1	Application is made by (full name), of (address), for a determination under the Common Boundaries Act 1981, section 7 (5).
2	The respondent to this application is (full name) of (address).
3	The applicant is the occupier of land situated at (address), being block            , section            , division of                             .
4	The respondent occupies adjoining land, being block            , section            , division of                       .
5	The fence separating the land of the respondent from that of the applicant was, on  		         , damaged (or destroyed) as a result of			                                               .
6*	It was necessary that the fence be repaired (or replaced) without delay in order to protect persons residing on the land of the applicant (or the respondent).
6*	It was necessary that the fence be repaired (or replaced) without delay in order to prevent the escape of animals from the land of the applicant (or the respondent).
7	The applicant repaired (or replaced) the fence at a cost of $		.
8	The applicant, on			          , gave to the respondent a notice in writing requesting the respondent to contribute to the cost of the repair (or replacement) of the fence.

Dated

(Signature of applicant or his or her representative)

†	The applicant is represented by (name and address of representative).
*	Strike out whichever is inappropriate
†	Strike out if  inappropriate

Endnotes
1	This form was originally in the Common Boundaries Act 1981 (the authorising Act), schedule.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the authorising Act and became a form approved under section 29 of that Act (see amdts 1.773 and 1.774). 
2	Under the Court Procedures Act 2004 A2004-59, pt 8, this form became a form approved under that Act. 
3	This republication includes amendments made under the Legislation Act, part 11.3 (Editorial changes).

©  Australian Capital Territory 2005