FORM 92A
rule 92.15(1)

IN THE SUPREME COURT				IN THE MATTER OF	
OF THE NORTHERN TERRITORY		the Criminal Property	
AT [DARWIN / ALICE SPRINGS]				Forfeiture Act 2002 and	
				IN THE MATTER of CD,	
File Number :  					
					
BETWEEN		AB		Applicant	
					
		and			
					
		CD		Respondent	
					
	EX PARTE APPLICATION		
The applicant applies for the following declaration(s) and/or order(s) against:

Dated: [date]
[Signed]
Filed: [date]

The Applicant's address for service is:
[The form is to include, in a Schedule if necessary, details of any property in respect of which an order is sought.]