4-961. 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. ______________________________, Respondent No. __________ 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: American LegalNet, Inc. www.FormsWorkFlow.com [] [] [] [] 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 respondent has the following weapons: _________________________ 3. [CHILD] [CHILDREN]2 A. List minor [child] [children] of either party. Name Date of Birth 2 Relationship of [Child] [Children] To You To Respondent 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 3 American LegalNet, Inc. www.FormsWorkFlow.com 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 respondent or the state: Type of Case Year Filed (if known) Case Number (if known) ______________ Where Filed (city and state) ____________ _ _ ______________ ______________ ______________ ______________ ______________ ______________ 5. DOMESTIC ABUSE A. The respondent committed the following act(s) of domestic abuse against me or a 4 American LegalNet, Inc. www.FormsWorkFlow.com 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. Has there been prior domestic abuse? [ ] yes [ ] no 5 American LegalNet, Inc. www.FormsWorkFlow.com 6. 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____________________________________________. [] (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. that law enforcement officers assist me in retrieving my clothing and personal belongings from the residence at __________________________________ 6 American LegalNet, Inc. www.FormsWorkFlow.com ______________________________________________. [] E. that I be given temporary custody of the [child] [children] listed in this petition. [] F. that until the court hearing: [] respondent shall have the following contact with the [child] [children]: ___________________________________________. [] respondent shall have no contact with the [child] [children]. [] G. 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. 7 American LegalNet, Inc. www.FormsWorkFlow.com [] 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 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 8 American LegalNet, Inc. www.