Form 16	Notice of motion—change of date
Domestic Violence and Protection Orders Regulation 2009, s 61
In the Magistrates Court of the Australian Capital Territory

DV/RO/WO ……/………………

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

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

I, (name)  …………...........................................................................................................
apply for:

The conference/hearing scheduled for ……….. …………………………….… be changed to……………………………………………………….. for the following reasons:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

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Signature

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

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

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Deputy Registrar