FORM 64A
SPECIAL CASE
(or as the case may be)
rule 64.05(e)
IN THE SUPREME COURT
OF THE NORTHERN TERRITORY
OF AUSTRALIA
AT [DARWIN / ALICE SPRINGS]
No. 							IN THE MATTER of
							[set out relevant
							legislative provision]
							AND IN THE MATTER of
							a Special Case [or as the
							case may be] stated by
							[specify court or as the)
							case may be], in
							[identify proceedings]
							for the opinion of the
							Court
							BETWEEN
							[full name]
							Applicant
							AND
							[full name]
							Respondent
SPECIAL CASE [or as the case may be] formulated for the opinion of the Court in pursuance of [state relevant provision].  
1.				
2.	[set out facts]	
3.				
QUESTION OF LAW
The question for the opinion of the Court is [state question]
The address for service of the applicant is: [address]
The address for service of the respondent is: [address]
DATED: [date]
(signature of Local Court Judge
or as the case may be.)