Form 4-962A. Counter-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 COUNTER-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 petitioner. [ ] We will need __________________ (describe other request for special help). 2. INFORMATION ABOUT THE PETITIONER (the person I am filing against) A. The petitioner 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 petitioner 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 Petitioner _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ 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 petitioner or the state: Type of Case Year Filed (if known) Case Number (if known) Where Filed (city and state) _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ 5. DOMESTIC ABUSE A. The petitioner 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. Petitioner 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 petitioner not contact me, not abuse me, and that the petitioner stay away from my residence [and] [place of employment] [and] [school]. [ ] B. (1) that the petitioner shall immediately leave [ ] my [ ] our residence at _______________________________________. [ ] (2) that the petitioner provide me with temporary suitable alternative housing. [ ] (3) ______________________________________ Provide (address of the place of eviction). [ ] C. that the petitioner shall not sell, remove, pawn, hide, destroy or damage any property owned by me or the two of us jointly. [ ] D. that law enforcement officers assist me in retrieving my clothing and personal belongings from the residence at ___________________________________. [ ] E. that I be given temporary custody of the [child] [children] listed in this petition. [ ] F. that until the court hearing: [ ] petitioner shall have the following contact with the [child] [children]: ___________________________________________________________________ __________________________________________________________________. [ ] petitioner shall have no contact with the [child] [children]: ___________________________________________________________________ __________________________________________________________________. [ ] G. that the petitioner shall pay: [ ] support for the [child] [children]. [ ] support for me. [ ] H. that the petitioner shall pay me for the damage and medical bills resulting from the abuse. [ ] I. other relief that is necessary to resolve this domestic abuse problem (list or describe what relief is necessary) ______________________________________________________________________ ______________________________________________________________________. [ ] J. the petitioner be found to be a credible threat and be required to deliver any firearm in the petitioner’s care, custody, or control to a law enforcement officer or a federal firearms licensee. 7. INFORMATION ABOUT THE RESPONDENT (ME) (If you do not want the petitioner 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 PETITIONER TO KNOW MY ADDRESS NOW OR AFTER THE HEARING FOR THE FINAL ORDER OF PROTECTION. I HAVE COMPLETED FORM 4-961B AND GIVEN IT TO THE COURT CLERK. OR [ ] B. My physical address is: _________________________________ in the [ ] County [ ] Indian Country of __________________, State of New Mexico. My mailing address (if different from above): _________________________________________________________ (street address) ___________________________________________________________ (city and zip) My telephone numbers are: Home Work Message __________________ __________________ __________________ 8. NOTICE TO PETITIONER [] A. I have not told petitioner 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 petitioner before coming to court. (Describe what might happen to you or what you are afraid might happen if the petitioner knew you were asking for a court order of protection.) _________________________________________________________________________ _________________________________________________________________________ [] B. I have told petitioner that I am filing this petition. 9. LOCATION OF PETITIONER A. Petitioner may be found at: ______________________________ (address) ______________________________ (city) ______________________________ (state and zip code) ______________________________ (if in Indian Country, please name tribe or pueblo). Petitioner's: ______________________________ (date of birth) ______________________________ (home telephone number) ______________________________ (work address) ______________________________ (work telephone number). B. Is petitioner in jail? [ ] yes [ ] no VERIFICATION I, the Respondent/Counter-Petitioner affirm under penalty of perjury under the laws of the State of New Mexico that I am the Respondent/Counter-Petitioner in the above- entitled cause; that I have read the counter-petition for order of protection from domestic abuse; and that the contents of the counter-petition are true and correct to the best of my information and belief. ________________________________ Date ________________________________ Signature of Respondent