Form 6	Summons to attend court—breach of community service order etc
Crimes Act 1914 (Cwlth)
(see s 20AC (Failure to comply with sentence passed, or order made, under subsection 20AB (1)))

In the *[Supreme/Magistrates Court] of the Australian Capital Territory Criminal jurisdiction

No *[SCC/CC]		of (year)		

Direction
To the offender:
You are directed to appear before the *[Supreme/Magistrates Court] at (insert address) on (insert date) at (insert time) to be dealt with under the Crimes Act 1914 (Cwlth), section 20AC (Failure to comply with sentence passed, or order made, under subsection 20AB (1)).

Details of the offender
Name:
Address:

Reason for summons
The following information is before me alleging that you have breached your *[community service order/(insert other order as appropriate)]:

(state briefly the alleged information)

Date:
Magistrate:

*omit if, or whichever is, inapplicable