File Number: lfr: Registry




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File Number:




LFR:




Registry



Form DV25

MAGISTRATES COURT OF QUEENSLAND


Domestic and Family Violence Protection Rules 2014

Rule 35
AFFIDAVIT


Aggrieved

(Insert Name)







Respondent

(Insert Name)







Applicant

(Insert Name)

I, (full name):…………………………………………………………………………..

of (address for service):………………………………………………………………

(occupation):…………………………………………………………………………..

state on oath (or: solemnly and sincerely affirm and declare):


1.
2.
3.

(Add more paragraphs as necessary)

Sheet 1
____________________________ ________________________

Deponent Solicitor/ Commissioner for

Declarations/Justice of the Peace



AFFIDAVIT

Name:

Filed on Behalf of (insert name):

Address for Service:

Domestic and Family Violence Protection Rules 2014.

Phone No*:




Email address*:

Rule 35

Fax No*:

*leave blank if you do not want this information to be given to the other party

The contents of this affidavit are true and correct to the best of my knowledge and belief, and where I have relied on information provided to me by another person or contained in a document I have stated the source of that information, and if contained in a document have attached that document to this affidavit.

I understand that it is a criminal offence to provide false information in the affidavit.

Each page of the affidavit must be numbered.

At the end of the body of the affidavit:

SWORN [or Affirmed] by (full name).……………………………………………….

at (insert place) on the day of 20 in the presence of

____________________________ ______________________



Deponent Solicitor/ Commissioner for Declarations/Justice of the Peace

Form DV25 - Version 1, 28 February 2015


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