Circuit Court Forms

FORM 34B

AN CHÚIRT CHUARDA
THE CIRCUIT COURT

                   CIRCUIT                                                                                             COUNTY OF
 

IN THE MATTER OF THE GRAND JURY (IRELAND) ACT, 1836, AS AMENDED, AND IN THE MATTER OF .............., APPLICANT

APPLICATION FOR COMPENSATION FOR CRIMINAL INJURY TO THE PERSON

BETWEEN

…………………. Plaintiff

AND

..…………………. Defendant


WHEREAS some person or persons did, on the .... day of .................... at (describe location) ………............. in the County of ............ maliciously maim/murder ......…........, a witness against ................ charged with an offence against the public peace
 

OR a Magistrate/Peace Officer in the discharge of his duty
 

PARTICULARS OF INJURY
 

NOTICE IS HEREBY GIVEN that an application will be made by or on behalf of the above named Plaintiff (being the legal personal representative of the said ..................... deceased) to the Circuit Court sitting at .................... in the County of ....................... on the ..... day of ........ or on the first available day thereafter, for compensation in such sum as the Court shall think just and reasonable, to be raised as provided for in Section 106 of the Act.
 

Dated the ........ day of ...............

Signed ..............……............... 
Applicant/Solicitor for the Applicant

To: The County Secretary/Town Clerk of .................. (Local Authority)

And

To: The County Registrar