CIVIL FORM 4-962A Supreme Court Approved October 29, 2008 STATE OF NEW MEXICO FIRST JUDICIAL DISTRICT COURT COUNTY OF ____________________ ________________________________________,Petitioner v. No. __________ ________________________________________,Respondent COUNTER-PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE1 1. COURT ASSISTANCE REQUEST [] [] 2. We will need an interpreter in __________________ to translate at hearings for [ ] me [ ] the petitioner. We will need __________________ (describe other request for special help). 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) [] [] B. 3. a person who has sexually assaulted me a person who has stalked me The petitioner has the following weapons: __________________. [CHILD][CHILDREN] A. List minor [child] [children] of either party. American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-962A Supreme Court Approved October 29, 2008 Name _______________ Date of Birth ______________ Relationship of [Child] [Children] 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 ________________________ _______________________________ ________________________ 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 Case Number Where Filed (if known) (if known) (city and state) ______________ ______________ ______________ ______________ ______________ ______________ ______________ ______________ 2 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-962A 5. Supreme Court Approved October 29, 2008 DOMESTIC ABUSE 1. 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. Others present during the abuse:___________________________________ C. Did drugs or alcohol play a role in the domestic abuse? [ ] yes [ ] no D. Were weapons used during the abuse? [ ] yes [ ] no. If yes, what weapons? ________________________________________ E. 6. Has there been prior domestic abuse? [ ] yes [ ] no. REQUESTS TO THE COURT I REQUEST THAT THE COURT ORDER (check all that you want): [] A. petitioner that the petitioner not contact me, not abuse me and that the 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 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-962A Supreme Court Approved October 29, 2008 [] 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. [] E. that law enforcement officers assist me in retrieving my clothing and personal belongings from the residence at ___________________ _________________________________. that I be given temporary custody of the [child] [children] listed in this petition. [] F. that until the court hearing: [] [] [] G. petitioner shall have the following contact with the [child] [children]:_________________________________________ ______________________________________________. petitioner shall have no contact with the [child] [children]: _______________________________________________ _______________________________________________. that the petitioner shall pay: [] support for the [child] [children] [] support for me. [] [] 7. 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): ________________________________________________________ ____________________________________________________. 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) 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 4 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-962A Supreme Court Approved October 29, 2008 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 is: ________________________________________ (street address) ________________________________________ (city and zip) My telephone numbers are: Home Work Message ________________ ________________ ________________ 8. NOTICE TO PETITIONER [] I have not told petitioner that I am filing a counter-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.) _____________________________________________________ ______________________________________________________. [] 9. A. B. I have told petitioner that I am filing this counter-petition. LOCATION OF PETITIONER A. Petitioner may be found at: ______________________________ ______________________________ ______________________________ ______________________________ tribe or pueblo). Petitioner's: ______________________________ ______________________________ ______________________________ ______________________________ (address) (city) (state and zip code) (if in Indian Country, please name (date of birth) (home telephone number) (work address) (work telephone number). 5 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-962A B. Supreme Court Approved October 29, 2008 Is petitioner in jail? [ ] yes [ ] no 6 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-962A Supreme Court Approved October 29, 2008 VERIFICATION STATE OF NEW MEXICO COUNTY OF ___________________ TRIBE OR PUEBLO ______________ ) ) ) The respondent was sworn and states: I, the Respondent/Counter-Petitioner, being duly sworn upon my oath, depose and state that I am the Respondent/Counter-Petitioner in the above-entitled cause and I have read the counter-petition for order of protection from domestic abuse. I state that the contents thereof are true and correct to the best of my information and belief. ____________________________ Date __________________________________ Signature of Respondent Signed and sworn before me on this ________ day of ______________, __________. Notary public ______________________________ My commission expires: ______________________________. 1. 2. USE NOTES Respondent should complete all information known by the respondent. This part must be completed if there are children. Section 40-10A-209 NMSA 1978 of the Uniform Child-Custody Jurisdiction Enforcement Act requires the first pleading of every custody action to give information under oath as to the child's present address, the places where the child has lived within the last five (5) five years and the names and present addresses of the persons with whom the child has lived during that period. If a child lives with you now, but you do not want petitioner to know your address, do not put your current address here, but do fill out Forms 4-961A and 4-961B NMRA. 7 American LegalNet, Inc. www.FormsWorkFlow.com