[Signature] PART 2—PARTICULARS OF HEARING (to be completed by the Registrar) The application will be heard before the Judge/Associate Judge in the Court, County Court, William Street, Melbourne, on [e.g. ] 20 June, 20 at a.m. [or p.m.] or so soon afterwards as the business of the Court allows. [e.g. ]. 15 June, 20 __________________ Rule 16.02(1)(b) 2–16B AFFIDAVIT [heading as in application] 1. I, [name c/o the Registrar, County Court at of applicant], [or [occupation], am a parent of [insert insert address of applicant], full name[s] of child/children whose name[s] *is/*are sought to be changed]. 2. The date of birth of [name is— of child] [Insert extra name[s] and dates[s] of birth if application is for more than one child and the Respondent is the other parent of the other child/children] 3. The other parent of the *child/*children is the Respondent in these proceedings whose full name and address is— [Insert details] *4. That I was married to the Respondent at on [insert date]. or *4. That I had a de facto relationship with the Respondent from [insert date]. 5. That I last resided with the Respondent on [insert date].
[Signature] PART 2—PARTICULARS OF HEARING (to be completed by the Registrar) The application will be heard before the Judge/Associate Judge in the Court, County Court, William Street, Melbourne, on [e.g. 20 June, 20 ] at a.m. [or p.m.] or so soon afterwards as the business of the Court allows. [e.g. 15 June, 20 ]. __________________ Rule 16.02(1)(b) 2–16B [heading as in application] 1. I, [name of applicant], c/o the Registrar, County Court at [or insert address of applicant], [occupation], am a parent of [insert full name[s] of child/children whose name[s] *is/*are sought to be changed]. 2. The date of birth of [name of child] is— [Insert extra name[s] and dates[s] of birth if application is for more than one child and the Respondent is the other parent of the other child/children] 3. The other parent of the *child/*children is the Respondent in these proceedings whose full name and address is— [Insert details] *4. That I was married to the Respondent at on [insert date]. or *4. That I had a de facto relationship with the Respondent from [insert date]. 5. That I last resided with the Respondent on [insert date]. AFFIDAVIT
09-56sr007.docx