File Number

	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

APPLICATION FOR UNLEASED
LAND DETERMINATION
		
	Common Boundaries Act 1981, section 7(2)		

APPLICANT’S DETAILS	
Name	 
	
Address line 1	
 	
Address line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
APPLICANT’S REPRESENTATIVES DETAILS (IF ANY)	
Name

Address line 1	
 	
Address line 2	
 	
Telephone	                                                                    Fax:                                       
Email:	
RESPONDENT’S DETAILS	
 Name		
Address line 1		
Address line 2		
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
Telephone	                                                                    Fax:                                       
Email:	
Details of application
*omit if, or whichever is, inapplicable
1	The applicant occupies land situated at________________________________                        
           
 ,being block_______________, section___________, division 

of___________                                  
            (the applicant’s land).
2	The respondent occupies land situated at___________________, being 

block________, section____________________, division of______________
(the respondent’s land).

3	The adjoining land became a parcel of land for the Common Boundaries Act 1981, division 2.1, being block_________, section__________, division of_____________(the respondent’s land) *[within/not earlier than] 6 months after the date the applicant began erecting the fence.

*4	The fence erected is a basic fence.  The cost of erecting the fence is $_______.

*4	The fence erected is not a basic fence.  The cost of erecting the fence is $____.  The cost of erecting a basic fence is estimated at $______________.

5	The applicant proposes that the respondent contribute $__________________to the cost of the fence.

*6	The respondent has refused to contribute to the cost of erecting the fence.

*6	The applicant and respondent have not been able to agree upon the following matters:
	(set out the matters that cannot be agreed)

Date:

(signature of applicant or applicant’s representative)

(name of applicant or applicant’s representative)