Form 12	Application if service impracticable or impossible
Domestic Violence and Protection Orders Act 2008, s 66
In the Magistrates Court of the Australian Capital Territory

DV/RO/WO ……. /………………

APPLICANT			.........................................................................

RESPONDENT		...................................................................

I, (name)   … ….... ....... ...... ... ......... ....... ...... ...... ....... ...... ...... ......... ...... ....... .........
apply for an order that:
under the Domestic Violence and Protection Orders Act 2008, section 66 
the following document/s*: 
Notice of Proceeding;
application dated (date) ……………………….;
endorsement copy of Interim PPO dated (date) ……………………;
Interim PPO dated (date) ………………………………..;
other (please specify) ……………………………………… dated (date)……………………
may be served, together with a copy of the order made on this application and a letter from the Registrar about the order, in the following way:  
(set out the way of service that is likely to bring the application or document to the attention of the person to be served)
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* strike out document if inapplicable

Attempts at service:
The following attempts to serve the documents have been unsuccessful:
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Signature

NOTE:  This application is set down for hearing on the................ day of ........................, 20……. at..................................., at the Magistrates Court at Knowles Place, Canberra.

Dated this ...................................... day of .......................................................... 20…….

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Deputy Registrar