FORM 81A-S
rule 81A.41(12)
IN THE SUPREME COURT 	    
OF THE NORTHERN TERRITORY 				
OF AUSTRALIA			   
AT [DARWIN OR ALICE SPRINGS]

File No: [file number]
BETWEEN
THE KING
and
[NAME OF PERSON TO WHOM SUMMONS ISSUED]
SUMMONS
To: [name of person to whom summons issued]
You have failed without reasonable excuse to comply with the following condition of a [community service order/ home detention order] made under the Sentencing Act 1995:
 [give details of the condition and the failure to comply]
You are summoned to attend the [Court] at the Supreme Court Building [State Square, Darwin / 14 Parsons Street, Alice Springs] on [date] at [time] or so soon afterwards as the business of the Court allows.
FILED: [date]
This summons is issued under [section 39(2) / 48(2)(a)] of the Sentencing Act 1995.