Form 4-961. Petition for order of protection from domestic abuse.

[Family Violence Protection Act, Sections 40-13-1 to 40-13-8 NMSA 1978] STATE OF NEW MEXICO COUNTY OF _______________ __________________ JUDICIAL DISTRICT COURT _______________________________, Petitioner v. No. __________ _______________________________, Respondent PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE1 1. COURT ASSISTANCE REQUEST [ ] We will need an interpreter in __________________ to translate at hearings for [ ] me [ ] the respondent. [ ] We will need __________________ (describe other request for special help). 2. INFORMATION ABOUT THE RESPONDENT (the person I am filing against) A. The respondent is: [ ] my husband or [ ] my wife [ ] my ex-husband or [ ] my ex-wife [ ] the parent of my [child] [children] [ ] a family member _______________________________ (describe the family relationship) [ ] a person with whom I have had a continuing personal relationship _______________________________ (describe the relationship) [ ] a person who has sexually assaulted me [ ] a person who has stalked me B. The respondent has the following firearms (make/model): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (use additional page if needed) 3. INFORMATION ABOUT [CHILD] [CHILDREN]2 A. List minor [child] [children] of either party, even if from another relationship. Relationship of [Child] [Children] Name Date of Birth To You To Respondent _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ B. List address and with whom the [child] [children] are currently living. (List each child separately if [child] [children] do not reside with same person.) ________________________________________________________________________________ ________________________________________________________________________________ C. List each address where [child] [children] have lived during the last five (5) years. (List each child separately if [child] [children] did not reside with same person.) ________________________________________________________________________________ ________________________________________________________________________________ D. Does anyone else have physical custody of the [child] [children] or claim to have custody or visitation rights? [ ] yes [ ] no If yes, complete the following for the [child] [children]: Child’s name Person claiming rights ________________________ ________________________ ________________________ ________________________ E. Describe how often the [child] [children] have been with the other party during the past six (6) months. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 4. OTHER CASES [ ] The following divorce, separation, order of protection, child support, paternity, abuse or neglect cases have been previously filed by me, the respondent or the state: Type of Case Year Filed (if known) Case Number (if known) Where Filed (city and state) _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ 5. DOMESTIC ABUSE A. The respondent committed the following act(s) of domestic abuse against me or a member of my household: (describe in detail what happened to you or to a member of your household and when and where.) Physical abuse: __________________________________________________________________. Threats which caused fear that you or any household member would be injured: _______________________________________________________________________________. Other abuse: ____________________________________________________________________. Date of abuse: __________________________________________________________________. Place of abuse: __________________________________________________________________. B. Respondent is a credible threat to my physical safety because: ________________________________________________________________________________ _______________________________________________________________________________. C. Others present during the abuse: __________________________________________. D. Did drugs or alcohol play a role in the domestic abuse? [ ] yes [ ] no E. Were weapons used during the abuse? [ ] yes [ ] no If yes, describe the weapons? F. Has there been prior domestic abuse? [ ] yes [ ] no [continuation sheets to be inserted here] 6. REQUESTS TO THE COURT I REQUEST THAT THE COURT ORDER (check all that you want): [ ] A. that the respondent not contact me, not abuse me, and that the respondent stay away f [ ] B. (1) that the respondent shall immediately leave [ ] my [ ] our residence at ____________ [ ] (2) that the respondent provide me with temporary suitable alternative housing. [ ] C. that the respondent shall not sell, remove, pawn, hide, destroy or damage any property [ ] D. that law enforcement officers assist me in retrieving my clothing and personal belonging [ ] E. that I be given temporary custody of the [child] [children] listed in this petition. [ ] F. that until the court hearing: [ ] respondent shall have the following contact with the [child] [children]: ______________________________________________________________ ______________________________________________________________ [ ] respondent shall have no contact with the [child] [children]. [ ] G. that the respondent shall pay: [ ] support for the [child] [children]. [ ] support for me. [ ] H. that the respondent shall pay me for the damage and medical bills resulting from the ab [ ] I. other relief that is necessary to resolve this domestic abuse problem (list or describe wh ___________________________________________________________________ ___________________________________________________________________. [ ] J. the respondent be found to be a credible threat and be required to deliver any firearm in licensee. 7. INFORMATION ABOUT THE PETITIONER (ME) (If you do not want the respondent to know your address and phone number, do not include it on this form. Tell the court clerk that you need to complete two other forms (Forms 4-961A and 4-961B NMRA) for your name and address and request that the clerk place your address under seal.) [ ] A. I DO NOT WANT RESPONDENT TO KNOW MY ADDRESS NOW OR AFTER TH AND GIVEN IT TO THE COURT CLERK. OR [ ] B. My physical address is: _________________________________ in the [ ] County [ My mailing address (if different from above): ______________________________________________________________________ (street address) ______________________________________________________________________ (city and zip) My telephone numbers are: Home __________________ Work __________________ Message __________________ 8. NOTICE TO RESPONDENT [ ] A . I have not told respondent that I am filing a petition to ask the court for an order of protection because I believe irreparable harm would result if I told respondent before coming to court. (Describe what might happen to you or what you are afraid might happen if the respondent knew you were asking for a court order of protection.) _____________________________________________________________ ________ _____________________________________________________________ ________. [ ] B . I have told respondent that I am filing this petition. 9. LOCATION OF RESPONDENT A. Respondent may be found at: ______________________________ (address) ______________________________ (city) ______________________________ (state and zip code) ______________________________ (if in Indian Country, please name tribe or pueblo). Respondent's: ______________________________ (date of birth) ______________________________ (home telephone number) ______________________________ (work address) ______________________________ (work telephone number). B. Is respondent in jail? [ ] yes [ ] no VERIFICATION I, the Petitioner, affirm under penalty of perjury under the laws of the State of New Mexico that I am the Petitioner in the above-entitled cause; that I have read the petition for order of protection from domestic abuse; and that the contents of the petition are true and correct to the best of my information and belief. ________________________________ Date ________________________________ Signature of Petitioner