Domestic Abuse Family Violence Protection Act

Petition for Order of Protection from Domestic Abuse

STATE OF NEW MEXICO

COUNTY OF

, Petitioner

v. No.

, Respondent

PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE

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

a family member

a person with whom I have had a continuing personal relationship

a person who has sexually assaulted me

a person who has stalked me

B. The respondent has the following weapons:

3. [CHILD] [CHILDREN]

A. List minor child/children of either party.

B. List address and with whom the child/children are currently living.

C. List each address where child/children have lived during the last five (5) years.

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:

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:

5. DOMESTIC ABUSE

A. The respondent committed the following act(s) of domestic abuse against me or a member of my household:

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

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

B.(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

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.

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.

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:

(city and zip)

My telephone numbers are:

Home Work Message

8. NOTICE TO RESPONDENT

A. 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.)

B. I have told respondent that I am filing this petition.

9. LOCATION OF RESPONDENT

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

VERIFICATION

I, the Petitioner, affirm under penalty of perjury under the laws of the State of New Mexico that I am the Petitioner in the above-entitled cause; that I have read the petition for order of protection from domestic abuse; and that the contents of the petition are true and correct to the best of my information and belief.

USE NOTE

1. Petitioner should complete all information known by the petitioner.

2. This part must be completed if there are children. NMSA 1978, Section 40-10A-209 of the Uniform Child-Custody Jurisdiction Enforcement Act requires the first pleading of every custody action to give information 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.

3. Use Notes 1 and 2 are to be printed on pre-printed forms published for use by pro se petitioners. This note and Use Note 4 should not be printed on the form.

4. NMSA 1978, Section 40-13-3.1(A)(4) provides that a victim 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; approved, as amended, effective May 1, 2001; as amended, effective February 16, 2004; as amended by Supreme Court Order No. 08-8300-40, effective December 15, 2008; as amended by Supreme Court Order No. 14-8300-023, effective for all pleadings and papers filed on or after December 31, 2014.]