CIVIL FORM 4-972 Supreme Court Approved October 29, 2008 STATE OF NEW MEXICO FIRST JUDICIAL DISTRICT COURT COUNTY OF __________________ STATE OF NEW MEXICO ON BEHALF OF: ________________________________________, Petitioner v. No. ____________ ________________________________________, Respondent. PETITION FOR EMERGENCY ORDER OF PROTECTION FROM DOMESTIC ABUSE 1. INFORMATION ABOUT THE RESPONDENT The respondent is: [] the husband of [ ] wife of petitioner [] the ex-husband of [ ] ex-wife of petitioner [] a family member of petitioner (describe relationship) [] a person with whom petitioner has had a continuing personal relationship. (describe relationship) [] a person who has sexually assaulted me [] a person who has stalked me ________ Petitioner's initials 2. CHILD(REN) List minor child(ren) who may be in immediate danger or in need of an order of temporary custody. Name Date of Relationship of Child Birth To Petitioner To Respondent _________________ ________________ ________________ ________________ _________________ ________________ ________________ _______________ _________________ ________________ ________________ _______________ American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-972 Supreme Court Approved October 29, 2008 _________________ ________________ ________________ _______________ _________________ ________________ ________________ _______________ ________ Petitioner's initials 3. DOMESTIC ABUSE 1. The respondent committed the following act(s) of domestic abuse against petitioner or the petitioner's child(ren). (describe in detail what happened and when and where) Physical abuse: _______________________________________________ ___________________________________________________ ___________________________________________________. Threats which caused fear that _________ or any household member would be injured: _____________________________________________ ______________________________________________________ _____________________________________________________________. Other abuse:_________________________________________________ _____________________________________________________ _____________________________________________________________. B. Others present abuse:___________________________________ during the 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. Has there been prior domestic abuse? [ ] yes [ ] no. ________ Petitioner's initials 4. REQUESTS TO THE COURT THE COURT IS REQUESTED TO ENTER AN EMERGENCY ORDER OF PROTECTION prohibiting respondent from abusing petitioner or any member of 2 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-972 Supreme Court Approved October 29, 2008 petitioner's household as follows: (check applicable) [] providing for law enforcement officers to assist [ ] petitioner [ ] respondent in retrieving [ ] petitioner's [ ] respondent's clothing and personal belongings from the residence at __________________. [] granting petitioner temporary custody of the child(ren) listed in this petition. [] prohibiting respondent from contact with the child(ren) listed in this petition. [] other relief that is necessary to resolve this domestic abuse problem (list or describe what relief is necessary): ________Petitioner's initials 5. 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 a separate form (Form 4-961B) 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 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 __________________ ________ Petitioner's initials 6. LOCATION OF RESPONDENT 3 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-972 Supreme Court Approved October 29, 2008 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 ________ Petitioner's initials OATH OF PETITIONER I SWEAR OR AFFIRM UNDER PENALTY OF PERJURY THAT THE FACTS SET FORTH ABOVE ARE TRUE TO THE BEST OF MY INFORMATION AND BELIEF. _____________________________ Date __________________________________ Signature of petitioner OATH OF LAW ENFORCEMENT OFFICER I swear or affirm under penalty of perjury that the facts set forth above are true to the best of my information and belief. I understand that it is a criminal offense subject to the penalty of imprisonment if I make a false statement in this petition. _____________________________ Date __________________________________ Signature of law enforcement officer 4 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-972 Supreme Court Approved October 29, 2008 5 American LegalNet, Inc. www.FormsWorkFlow.com CIVIL FORM 4-972 1. Supreme Court Approved October 29, 2008 USE NOTES Complete all information known by the officer. Section 40-13-3.1(A)(4) NMSA 1978 provides that the petitioner in a domestic abuse case shall not be required to pay for the filing, issuance or service of a petition for an order of protection. [Approved, effective November 1, 1999 until July 1, 2001; as amended, effective August 29, 2000; approved, effective May 1, 2001; as amended by Supreme Court Order No. 08-8300-40, effective December 15, 2008.] 6 American LegalNet, Inc. www.FormsWorkFlow.com