Form 4-1002. Petition for extreme risk firearm protection order.

[Extreme Risk Firearm Protection Order Act, NMSA 1978, Sections 40-17-1 to -13] STATE OF NEW MEXICO COUNTY OF __________________ __________________ JUDICIAL DISTRICT IN THE MATTER OF AN EXTREME RISK FIREARM PROTECTION ORDER FOR _______________________________ _____________________ (Respondent’s full date of birth) No. _________________________ PETITION FOR EXTREME RISK FIREARM PROTECTION ORDER SECTION I. PETITIONER (Petitioner must be a law enforcement officer working for a law enforcement agency as defined under the Extreme Risk Firearm Protection Order Act, NMSA 1978, Sections 40-17-1 to -13) Petitioner is employed by the following type of agency:  Police Department  District Attorney’s Office  Sheriff’s Office  Attorney General’s Office  State Police 1. Petitioner’s name: _________________________________________________ Badge/CAID Number: ______________________________________________ 2. Law Enforcement Agency Petitioner works for: ___________________________ 3. Law Enforcement Agency’s address: ___________________________________________________________________ street address __________________________________________ city __________ state __________ zip 4. Law Enforcement Agency’s telephone number: __________________________ SECTION II. PERSON WHO COMPLETED THE AFFIDAVIT OR STATEMENT In support of this petition, I am attaching as Exhibit A:  Affidavit of Reporting Party OR  Statement from the Law Enforcement Officer. A. Reporting Party 1. Reporting Party’s full name: __________________________________________ 2. Reporting Party’s relationship to Respondent: ____________________________ 3. Reporting Party’s address: ___________________________________________ a.  The Reporting Party has completed a Request to Omit the Reporting Party’s Contact Information. OR b. Reporting Party’s address (Do NOT complete if 3a is checked above) ___________________________________________________________________ street address __________________________________________ city __________ state __________ zip B. Law Enforcement Officer 1. Law enforcement officer’s full name: ___________________________________ 2. Law enforcement agency name: ______________________________________ 3. Law enforcement officer’s agency address: ___________________________________________________________________ street address __________________________________________ city __________ state __________ zip SECTION III. RESPONDENT 1. Respondent’s full legal name: ________________________________________ 2. Respondent’s date of birth: __________________________________________ 3. Respondent’s address: ___________________________________________________________________ street address __________________________________________ city __________ state __________ zip SECTION IV. BASIS FOR PETITION In support of this petition, the undersigned Law Enforcement Officer swears or affirms that based on credible information in the attached Exhibit A (select one option): ☐ Affidavit of the Reporting Party OR ☐ Statement from the Law Enforcement Officer there is probable cause to believe Respondent poses a significant danger of causing imminent personal injury to self or others by having custody or control of a firearm or by purchasing, possessing, or receiving a firearm. The undersigned Law Enforcement Officer has probable cause to believe the following factors should be considered by the Court when determining whether to issue a temporary extreme risk firearm protection order: ☐ A recent act or threat of violence by Respondent against self or others, regardless of whether the act or threat involved a firearm; ☐ A pattern of acts or threats of violence by Respondent within the past twelve (12) months, including acts or threats of violence against self or others; ☐ Respondent’s mental health history; ☐ Respondent’s use of controlled substances or alcohol; ☐ Respondent’s previous violations of any court order; ☐ Previous extreme risk firearm protection orders issued against Respondent; ☐ Respondent’s criminal history, including arrests and convictions for violent felony offenses, violent misdemeanor offenses, crimes involving domestic violence, or stalking; ☐ Respondent’s history of the use, attempted use, or threatened use of physical violence against another person; of stalking another person; or of cruelty to animals; and ☐ Any recent acquisition or attempts at acquisition of a firearm by Respondent. ☐ Other considerations: _______________________________________________ FIREARMS. The quantities, types, and total number of all firearms Petitioner believes to be in Respondent’s ownership, possession, custody, or control are listed below and/or attached as Exhibit B. Type of Firearm Number Location Ammunition ☐ Long gun (includes rifles and shotguns) ☐ Yes ☐ No ☐ Unknown ☐ Handgun (includes revolvers and pistols) ☐ Yes ☐ No ☐ Unknown ☐ Other (includes any other firearms): ☐ Yes ☐ No ☐ Unknown TOTAL NUMBER OF FIREARMS: ____________ LEGAL ACTION(S) BETWEEN REPORTING PARTY AND RESPONDENT. ☐ Lawsuit. Please describe: ___________________________________________ ☐ Complaint. Please describe: __________________________________________ ☐ Petition. Please describe: ____________________________________________ ☐ Restraining Order. Date Issued: ____________ Issued by: __________________ ☐ Injunction. Please describe: __________________________________________ ☐ Other Legal Action. Please describe: ___________________________________ ☐ None. For the foregoing reasons, Petitioner respectfully requests the court enter a Temporary Extreme Risk Firearm Protection Order and schedule a hearing to be held within ten (10) days of the issuance of a Temporary Extreme Risk Firearm Protection Order to determine if a One-Year Extreme Risk Firearm Protection Order should be entered. Respectfully submitted this ___________ day of ____________________, 20______. __________________________________________ Signature of Petitioner