Notice To Terminate A Civil Partnership

BIRTHS, DEATHS AND MARRIAGES NOTICE TO TERMINATE A CIVIL PARTNERSHIP Domestic Relationships Act 1994 Births, Deaths and Marriages Registration Act 1997 Births, Deaths and Marriages Registration Regulation 1998 Form 220 Registration Number (Office use only) Contact Phone number DETAILS OF PARTNERS PARTNER 1 PARTNER 2 Surname (As appears on your POI document) Given Name(s) (As appears on your POI document) Occupation Usual Place of Residence Place of Birth (City/Town, Australian State or Territory, or if born overseas, city/town and country) Date of Birth Mother s Maiden Surname Mother s Given Name(s) Father s Surname Father s Given Name(s) STATUTORY DECLARATION BY CIVIL PARTNER(S) Partner 1 Partner 2 I, (full name) I, (full name) being a (occupation) being a (occupation) of (address) of (address) Postcode Postcode hereby solemnly declare that I wish to terminate the civil partnership with ....