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 [] [] 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) [] a person who has sexually assaulted me [] a person who has stalked me B. The petitioner has the following weapons: __________________. 3. [CHILD][CHILDREN]2 A. Name _______________ List minor [child] [children] of either party. Date of Birth ______________ Relationship of [Child] [Children] To You To Petitioner ______________ ______________ American LegalNet, Inc. www.FormsWorkFlow.com _______________ _______________ _______________ _______________ 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]: Person claiming rights _______________________________ _______________________________ Child's name ________________________ ________________________ 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: Year Filed (if known) ______________ ______________ Case Number Where Filed (if known) (city and state) ______________ ______________ ______________ ______________ Type of Case ______________ ______________ 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: _________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com ____________________________________________________________. Date of abuse: ________________________________________________. Place of abuse: _______________________________________________. B. C. D. Others present during the abuse:___________________________________ Did drugs or alcohol play a role in the domestic abuse? [ ] yes [ ] no Were weapons used during the abuse? [ ] yes [ ] no. If yes, what weapons? ________________________________________ Has there been prior domestic abuse? [ ] yes [ ] no. E. 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]. (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). that the petitioner shall not sell, remove, pawn, hide, destroy or damage any property owned by me or the two of us jointly. 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. that until the court hearing: [] petitioner shall have the following contact with the [child] [children]:_____________________________________________ __________________________________________. [] petitioner shall have no contact with the [child] [children]: _______________________________________________ _______________________________________________. [] [] [] B. [] C. [] D. [] E. [] F. American LegalNet, Inc. www.FormsWorkFlow.com [] G. that the petitioner shall pay: [] support for the [child] [children] [] support for me. that the petitioner shall pay me for the damage and medical bills resulting from the abuse. other relief that is necessary to resolve this domestic abuse problem (list or describe what relief is necessary): ____________________________________________________________ ________________________________________________. [] H. [] I. 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