DISTRICT COURT CIVIL 4-961 Supreme Court Approved October 29, 2008 STATE OF NEW MEXICO FIRST JUDICIAL DISTRICT COURT COUNTY OF __________________ ______________________________, Petitioner v. No.____ __________ ______________________________, Respondent 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 respondent. [] We will need __________________ (describe other request for special help). 2. INFORMATION ABOUT THE RESPONDENT (the person I am filing against) A. The respondent 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 respondent has the following weapons: _________________________ [CHILD] [CHILDREN]2 American LegalNet, Inc. www.FormsWorkFlow.com DISTRICT COURT CIVIL 4-961 Supreme Court Approved October 29, 2008 A. List minor [child] [children] of either party. Name Date of Relationship of [Child] [Children] Birth To You To Respondent ______________ _____________ _____________ _____________ _______________ ______________ ______________ ______________ _______________ ______________ ______________ ______________ _______________ ______________ ______________ ______________ _______________ ______________ ______________ ______________ B. 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. 4. List address and with whom the [child] [children] are currently living. (List each child separately if [child] [children] do not reside with same person.) _____________________________________________________________ ____________________________________________________________ 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 ________________________ ______________________ ________________________ _______________________ OTHER CASES [] The following divorce, separation, order of protection, child support, paternity, abuse or neglect cases have been previously filed by me, the respondent or the state: Type of Case Year Filed Case Number Where Filed (if known) (if known) (city and state) ______________ ______________ ______________ ______________ American LegalNet, Inc. www.FormsWorkFlow.com DISTRICT COURT CIVIL 4-961 ______________ Supreme Court Approved October 29, 2008 ______________ ______________ ______________ 5. DOMESTIC ABUSE 1. The respondent 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. E. 6. Were weapons used during the abuse? [ ] yes [ ] no If yes, what weapons? ____________________________. Has there been prior domestic abuse? [ ] yes [ ] no REQUESTS TO THE COURT I REQUEST THAT THE COURT ORDER (check all that you want): [] A. that the respondent not contact me, not abuse me and that the respondent stay away from my residence [and] [place of employment] [and] [school]. [] B. (1) that the respondent shall immediately leave [ ] my [ ] our residence at____________________________________________. 3 American LegalNet, Inc. www.FormsWorkFlow.com DISTRICT COURT CIVIL 4-961 [] Supreme Court Approved October 29, 2008 (2) that the respondent provide me with temporary suitable alternative housing. [] C. that the respondent 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. respondent shall have the following contact with the [child] [children]: ________________________________________. respondent shall have no contact with the [child] [children]. that the respondent shall pay: [] support for the [child] [children] [] support for me. [] H. that the respondent 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): ______________________________________________________ ___________________________________________________. 7. 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 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 RESPONDENT TO KNOW MY ADDRESS NOW OR AFTER THE HEARING FOR THE FINAL ORDER 4 American LegalNet, Inc. www.FormsWorkFlow.com DISTRICT COURT CIVIL 4-961 Supreme Court Approved October 29, 2008 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 RESPONDENT [] I have not told respondent 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 respondent before coming to court. (Describe what might happen to you or what you are afraid might happen if the respondent knew you were asking for a court order of protection.) ________________________________________________________ ____________________________________________________. [] 9. A. B. I have told respondent that I am filing this petition. LOCATION OF RESPONDENT 1. 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). 5 American LegalNet, Inc. www.FormsWorkFlow.com DISTRICT COURT CIVIL 4-961 2. Supreme Court Approved October 29, 2008 Is respondent in jail? [ ] yes [ ] no 6 American LegalNet, Inc. www.FormsWorkFlow.com DISTRICT COURT CIVIL 4-961 Supreme Court Approved October 29, 2008 VERIFICATION STATE OF NEW MEXICO } COUNTY OF _________________ } TRIBE OR PUEBLO ______________ } The petitioner was sworn and states: I, the Petitioner, being duly sworn upon my oath, depose and state that I am the Petitioner in the above-entitled cause and I have read the 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 Petitioner Signed and sworn before me on this ________ day of ______________, __________. Notary public ______________________________ My commission expires: ______________________________. USE NOTES 1. Petitioner should complete all information known by the petitioner. 2. 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) 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 respondent to know your address, do not put your current address here, but do fill out Forms 4-961A and 4-961B. 7 American LegalNet, Inc. www.FormsWorkFlow.com