Form 4-1010. Petition to extend one-year 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 TO EXTEND ONE-YEAR EXTREME RISK FIREARM PROTECTION ORDER COMES NOW, the Petitioner, under the Extreme Risk Firearm Protection Order Act, NMSA 1978, Sections 40-17-1 to -13, and hereby requests the court extend the One- Year Extreme Risk Firearm Protection Order in this case for one (1) additional year, and as grounds alleges that: SECTION I. ONE YEAR EXTREME FIREARM PROTECTION ORDER INFORMATION 1. A One-Year Extreme Risk Firearm Protection Order was entered against the respondent on ____________________________ (date). 2. The One-Year Extreme Risk Firearm Protection Order expires on _________________________ (date). SECTION II. PERSON WHO COMPLETED THE AFFIDAVIT OR STATEMENT A. Reporting Party (Affidavit of Reporting Party attached as Exhibit A) 1. Reporting Party’s full name: ________________________________________ 2. Reporting Party’s relationship to Respondent: __________________________ The reporting party has completed Request to Omit the Reporting Party’s Contact Information ☐ ADDRESS SEALED 3. Reporting Party’s address: ______________________________________________________________________ street address _____________________________________, _____________ _________________ city state zip B. Law Enforcement Officer (Law Enforcement Statement attached as Exhibit A) 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 and 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 continues to pose 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, which occurred since the entry of the One-Year Extreme Risk Firearm Protection Order on _________________________________ (date), should be considered by the court when determining whether to extend the One-Year 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: _______________________________________________ ___________________________________________________________________ ___________________________________________________________________ Respectfully submitted this_________ day of ____________________, ____________. day month Year ______________________________________ Signature of Petitioner ____________________________________ Printed Name of Petitioner ______________________________________ Law Enforcement Agency ______________________________________ Badge/CAID number CERTIFICATE OF SERVICE I HEREBY CERTIFY that on _____________________________ (date) a copy of this Petition to Extend One-Year Extreme Risk Firearm Protection Order was personally served on Respondent at ______________________________________________________________________ street address _____________________________________, _____________ _________________ city state zip ____________________________________ Signature of Petitioner