Form 14	Application to amend or revoke recognised non-local FVO
Family Violence Act 2016
(see pt 5, pt 6 and div 9.3)

In the Magistrates Court of the Australian Capital Territory

FVO ........ / 20........
...................................................................................................................(full name)
Applicant
...................................................................................................................(full name)
Respondent

Order type:	interstate FVO / registered foreign order (New Zealand			FVO/ FVO declared under subdivision 9.6.3)
		interim / final
			(Circle whichever is applicable)
	□	I am a protected person under the recognised non-local FVO
	□	I am the applicant to amend or revoke the recognised non-local 		FVO but not a protected person under it
	□	I am the respondent to the recognised non-local FVO 
	□	Other (please specify your interest in the recognised non-local 		FVO)
(Tick whichever is applicable, and for ‘other’ attach details of your interest)

Details of recognised non-local FVO 
Non-local FVO number:..........................
Date of issue:		.......................................... /20........
Issuing authority:	.............................................................(Name of police or court)
Jurisdiction:		..............................................................(State, territory or NZ) 
*If amended, date of amendment	...................../20......... 
by ..........................................................................................(amending court)
in ................................................................................................(jurisdiction)
	□	*The recognised non-local FVO /* A certified copy of the 		recognised non-local FVO is attached 

To the Registrar of the Magistrates Court:

I, .............................................................................................................. (full name) 
*apply to have the recognised non-local FVO referred to above amended:

*by extending the order in the same terms for the following period:
______ /______ /20______ to ______ /______ /20______
OR

*as follows: ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 
*for the period of the order OR *for the following period:
______ /______ /20______ to ______ /______ /20______
This application is made on the following grounds:
................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 
OR, 
*apply to have the non-local FVO revoked and seek the following orders:
*That leave be granted by the Court to bring an application for revocation. 
(If applicant for revocation is respondent to the non-local FVO or ‘other’)

That the original order be revoked.

This order is sought for the following reasons:
................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 

................................................................... Dated: ______ /______ /20_____
(Signature of applicant, or applicant’s solicitor)

................................................................................................................................
(Name of applicant, or applicant’s solicitor)

*delete if inapplicable
□ tick if applicable