Form 4	Domestic Violence and Protection Orders Act 2001
(see s 13)
Application for amendment or revocation of order

Australian Capital Territory

I (applicants name)
now apply to have magistrates court order (order number)	revoked/varied as follows:

[Signature]	
Applicant	

NOTE:	This application is set down for hearing on the 	day of		
20 	at 	am/pm at the Magistrates Court at	
Dated this 	day of		20	.

[Signature]
Registrar

Endnotes
This republication includes amendments made under the Legislation Act, part 11.3 (Editorial changes).

©  Australian Capital Territory 2006