I have notified the respondent of my intention to withdraw my

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I have notified the respondent of my intention to withdraw my Powered By Docstoc
					                                                                                                                         Form FVIO9

                                                                                  NOTICE OF WITHDRAWAL OF AN
                                                                                          INTERVENTION ORDER
                                                                                                       Family Violence Protection Act 2008




In the Magistrates’ Court at                                                            Case no


Applicant

Current address

Protected person

Current address


Do you wish to disclose your address?                         Yes            No


Additional protected person(s)


Respondent

Current address



I,
                                                                    (your name)

wish to withdraw my application against

                                                                    (name of respondent)

Reasons for withdrawal: (please state reason/s)




I have notified the respondent of my intention to withdraw my application by:

      phone on                     (date)         SMS / text on                         (date)    email dated                       (date)


      fax on                       (date)         letter on                             (date)    in person on                      (date)


      other                 on                (date)

OR: I have NOT notified the respondent of my intention to withdraw my application because:(please state reason/s)




Signed:                                                        Date:


Office use only:            Correspondence attached                               Yes             No

                             For further information contact your local Magistrates’ Court of Victoria or visit
                                               www.magistratescourt.vic.gov.au
     FVIO9 September 2011                                                                                                    Page 1 of 1

				
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