Form 5	Small Claims Court—application under Common Boundaries Act 1981, section 6 (5)
Common Boundaries Act 1981

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 determination under the Common Boundaries Act 1981, section 7 (5).
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 application
1	The applicant occupies land situated at (address) being block (number), section (number), division of (name of division) (the applicant’s land).
2	The respondent occupies land situated at (address), being block (number), section (number), division of (name of division) (the respondent’s land).
3	On (date), the fence separating the applicant’s land and the respondent’s land was *[damaged/destroyed]. 
*4	It was necessary to *[repair/replace] the fence without delay to protect people living in premises on the *[applicant’s/respondent’s] land. 
*4	It was necessary to *[repair/replace] the fence without delay to prevent the escape of animals from the *[applicant’s/respondent’s] land. 
5	The applicant *[repaired/replaced] the fence at a cost of $ (amount).
6	On (date), the applicant requested the respondent to contribute to the cost of the *[repair/replacement] of the fence.

Date:

(signature of applicant or applicant’s representative)
(name of applicant or applicant’s representative)
*omit if, or whichever is, inapplicable