Form 4-968. Application to modify, terminate, or extend the order of protection from domestic abuse.

[Standard simplified domestic abuse form, 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 APPLICATION TO MODIFY, TERMINATE, OR EXTEND THE ORDER OF PROTECTION FROM DOMESTIC ABUSE [ ] Petitioner [ ] Respondent asks the court: (check and complete applicable alternatives) [ ] to modify the protection order as follows: _______________________________ ________________________________________________________________. [ ] to terminate the protection order because: ______________________________ ________________________________________________________________. [ ] to extend the protection order for an additional____________(days) (months) because: ______________________________________________________________ _____________________________________________________________________. The other party: [ ] objects to the extension, modification, or termination of the protection order. [ ] agrees to the extension, modification, or termination of the protection order. [ ] has not told me whether (he) (she) objects or agrees to the extension, modification, or termination of the protection order. VERIFICATION I, the [ ] Petitioner [ ] Respondent, affirm under oath and penalty of perjury under the laws of the State of New Mexico that I am the [ ] Petitioner [ ] Respondent in the above- entitled cause; that I have read this application to modify, terminate, or extend the order of protection from domestic abuse; and that the contents of the application are true and correct to the best of my information and belief. ________________________________ Date ________________________________ Signature of party filing this application STATE OF NEW MEXICO ) COUNTY OF _____________ ) ss TRIBE OR PUEBLO ______________ ) Signed and sworn before me on this ____ day of _____________, ______. _________________________________ Notary public My commission expires: _______________________. CERTIFICATE OF SERVICE I hereby certify that on this ____ day of ______________, ______ this application was [mailed by United States mail, postage prepaid, and addressed to: Name: _____________________________________________ Address: _____________________________________________ City, State and zip code: __________________________________] [faxed by ________________________ (name of person who faxed document) to ______________________ (name of recipient) at _________________ (telephone number). The transmission was reported as complete and without error. The time and date of the transmission was ________ (a.m.) (p.m.) on _____________________ (date).] [e-mailed by __________________________ (name of person who transmitted) to ______________________ (name of recipient) at _________________ (electronic mail address of recipient) who agreed to service in this manner. The transmission was successful. The time and date of the transmission was _________ (a.m.) (p.m.) on _____________________ (date).] ________________________________ Signature of attorney ________________________________ Date of signature If this notice was served by a person other than an attorney, the following must also be completed and filed with the court: AFFIDAVIT OF SERVICE I affirm under penalty of perjury under the laws of the State of New Mexico that a copy of this application was served by [mail] [fax] [electronic transmission] as described above on this ________ day of ______________, __________. ________________________________ Signature of person who made service