Sample Apprehended Personal Violence Order Application - text only version
This is a text only version of a Sample Application for Apprehended Personal Violence Order. It is not legal advice.
To see what a completed Application for Apprehended Personal Violence Order could look like, see the pdf version of
Sample Application Apprehended Personal Violence Order 
(27 kb).
If you need more help, you should get legal advice.
APPLICATION FOR
APPREHENDED PERSONAL VIOLENCE ORDER
Crimes (Domestic and Personal Violence) Act 2007
Application Details
Case Number: 20XX/000000001
Applicant Details
Name: Didier Hasan
Protected Persons Details
Didier Hasan, Male, 10 March 1981.
Relationship to Defendant: The protected person is not related to the defendant.
Defendant Details
Name: Mark Howard
Date of Birth/Age:
Address: 319 Pith Street MERRYLANDS NSW 2160
Notice to Defendant:
You are directed to attend the Fairfield Local Court on:
Date: 8 December 20XX
Time: 9:30 AM
Place: Fairfield Local Court
Spencer Street FAIRFIELD NSW
If you fail to attend, the court may make orders against you or issue a warrant for your arrest to bring you before the court.
You can get further information about this document from:
- The court registry
- A legal practitioner
- LawAccess NSW on 1300 888 529 or at www.lawaccess.nsw.gov.au
Grounds of Application:
The applicant has recently migrated from Africa and moved into a house located at 321 Pith Street, Merrylands with his wife.
The defendant, Mr. Mark Howard resides at 319 Pith Street, Merrylands.
The defendant has been doing a lot of work around his house. The applicant has found some building rubble and garbage thrown over the fence into his yard.
The applicant has approached the defendant on numerous occasions and asked him to keep his rubbish on his property. The defendant has continued to throw rubbish over the fence into the applicant’s property.
On 3 November 20XX the applicant received an anonymous letter containing numerous threats to him, his wife and their property. The applicant believes it was the defendant who placed this letter in his letterbox as every time he leaves the house the defendant comes out of his house and yells at him and threatens him.
The applicant feels threatened by the defendant and is fearful for his safety and the safety of his family.
The applicant would like the court to make an Apprehended Personal Violence Order.
EXISTING FAMILY LAW ORDERS:
Nil
Orders Sought:
The applicant requests that the court make the following orders against the defendant for a period of: 12 months
Orders about behaviour
1. You must not do any of the following to Didier Hasan, or anyone he has a domestic relationship with:
A) assault or threaten him,
B) stalk, harass or intimidate him, and
C) Intentionally or recklessly destroy or damage any property or harm an animal that belongs to or is in the possession of Didier Hasan.
Orders about where you cannot go
8. You must not go into:
A) any place where Didier Hasan lives, or
B) any place where he works, or
C) any place listed here 321 Pith Street Merrylands NSW 2160 .
Other orders
11. That the court extend the operation of the orders to include the following person(s), with whom the protected person has a domestic relationship: Saabeah Hasan, date of Birth: 1/9/1983.
Date of Filing Application: 15 November 20XX 3:30 PM