Form 4-961B. Request for order to omit petitioner's address and telephone number from petition, to place references to petitioner's address under seal and for an order providing alternative means of service on petitioner.

[Standard simplified request to seal petitioner’s address form, Family Violence Protection Act, Sections 40-13-1 to 40-13-8 NMSA 1978] __________________ JUDICIAL DISTRICT COURT COUNTY OF _______________ STATE OF NEW MEXICO _______________________________ Petitioner v. No. ____________ _______________________________ Respondent REQUEST FOR ORDER TO OMIT PETITIONER’S ADDRESS AND TELEPHONE NUMBER FROM PETITION, TO PLACE REFERENCES TO PETITIONER’S ADDRESS UNDER SEAL AND FOR AN ORDER PROVIDING ALTERNATIVE MEANS OF SERVICE ON PETITIONER 1. I do not want my current address and telephone number to be made known to the respondent for the following reasons: _____________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 2. My current mailing address and telephone number are: ____________________________________ (address) ____________________________________ (city, state and zip code) My telephone numbers are: phone number work phone message phone ________________ ________________ ________________ 3. I ask the court not to disclose my current address and telephone number. 4. I ask that if my request is granted, all process and papers be served on me by delivering them to the clerk of the court who shall serve me at my current address. 5. I agree that if either my address or telephone number change during this lawsuit, I will immediately file another form like this one giving my new address or telephone number. VERIFICATION I, the petitioner, affirm under penalty of perjury under the laws of the State of New Mexico that I have read the above information; that it is true to the best of my knowledge and belief; and that I understand that I can be punished both civilly and criminally if any information in this request is false. ___________________________ Date ________________________________ Signature of petitioner ________________________________ Petitioner’s street address ________________________________ (City, state and zip code) I have reviewed this request [ ] I recommend that the request be granted. [ ] I recommend that the request be denied. ________________________________ Signed ________________________________ Title ________________________________ Court’s telephone number [ ] Request of petitioner is granted. The respondent shall serve all pleadings and other papers required to be served by filing them with the clerk who will note on the pleading or papers the date and manner of service. The clerk shall promptly serve such pleadings and papers on the petitioner, noting in the court file the date and manner of service upon petitioner. [ ] Request of the petitioner is denied. The petitioner shall place petitioner’s name, address and phone number in the appropriate places on the petition prior to service of the petition upon the respondent. ________________________________ District Judge ________________________________ Date