Fill and Sign the Order of Protection Against Petitioner 4 971pdf Fpdf Form

2 4-971. Stipulated order of protection against petitioner. ADDITIONAL PAGES 1 OF STIPULATED ORDER OF PROTECTION AGAINST The court further FINDS, CONCLUDES AND ORDERS: (check only applicable paragraphs) 1. NOTICE, APPEARANCES AND STATUS This order was entered on stipulation of the parties. [ ] The relationship of the parties is that of an "intimate partner" as defined in 18 USC Section 921(a)(32). (See 2 below) 2. EFFECT OF STIPULATION TO ORDER OF PROTECTION Violation of this order can have serious consequences, including: A. If you violate the terms of this order, you may be charged with a misdemeanor, which is punishable by imprisonment of up to three hundred sixty-four (364) days and a fine of up to one thousand dollars ($1,000) or both. You may be found to be in contempt of court. B. If you are the spouse or former spouse of the other party, an individual who cohabitates with or has cohabitated with the other party, or if you and the other party have had a child together, federal law prohibits you from possessing or transporting firearms or ammunition while this order is in effect. If you have a firearm or ammunition, you should immediately dispose of the firearm or ammunition. Violation of this law is a federal crime punishable by imprisonment for up to ten (10) years and a fine of up to two hundred fifty-thousand dollars ($250,000). C. If you are not a citizen of the United States, violation of this order may have a negative effect on your application for residency or citizenship. 3. DOMESTIC ABUSE PROHIBITED The petitioner shall not abuse the respondent or members of the respondent's household. "Abuse" means any incident by petitioner against the respondent or respondent's household member resulting in (1) physical harm; (2) severe emotional distress; (3) bodily injury or assault; (4) a threat by petitioner causing imminent fear of bodily injury to respondent's or respondent's household members; (5) criminal trespass; (6) criminal damage to property; (7) repeatedly driving by respondent's or 3 respondent's household members' residence or workplace; (8) telephone harassment; (9) stalking; (10) harassment; or (11) harm or threatened harm to children in any manner set forth above. Petitioner shall not ask or cause other persons to abuse the respondent or respondent's household members. 4. CONTACT PROHIBITIONS Petitioner shall stay ____________ yards away from the respondent and the respondent's home and workplace at all times, unless at a public place, where the petitioner shall remain ____________ yards away from the respondent except as specifically permitted by this order. Petitioner shall not telephone, talk to, visit or contact respondent in any way except as follows: [ ] The parties may contact each other by telephone regarding medical emergencies of minor children; [ ] ________________________________________________ _________________________________________________. [ ] The parties may attend joint counseling sessions at the counselor's discretion. (Unless the court has entered an order sealing the protected party’s address, include it below.) Protected party’s addresses ________________________________________ (home address) ________________________________________ (work address) ________________________________________ (city) ________________________________________ (if applicable, tribe or pueblo) ________________________________________ (state and zip code) 5. COUNSELING [ ] Petitioner shall attend and complete counseling at __________________, contacting that office within five (5) days. The petitioner shall participate in, attend and complete counseling as recommended by the named agency. [ ] Respondent shall attend and complete counseling at __________________, contacting that office within five (5) days. The respondent shall participate in, attend and complete counseling as recommended by the named agency. [ ] Petitioner shall report to __________________ for a [ ] drug [and] [ ] alcohol screen by ______________, __________ (date) with the results returned to this court. 4 [ ] Respondent shall report to __________________ for a [ ] drug [and] [ ] alcohol screen by ______________, __________ (date) with the results returned to this court. [ ] Other counseling requirements: _______________________________ _____________________________________________________. 6. CUSTODY 2 [ ] The court's orders regarding the minor [child] [children] of the parties are found in the Custody, Support and Division of Property Attachment of this order of protection. 7. PROVISIONS RELATING TO SUPPORT 2 [ ] The court's orders regarding support issues for the parties are found in the Custody, Support and Division of Property Attachment of this order of protection. 8. PROPERTY, DEBTS, PAYMENTS OF MONEY 2 [ ] The court's orders regarding property, debts and payment of money are addressed in the Custody, Support and Division of Property Attachment of this order of protection. 9. ADDITIONAL ORDERS [ ] Review hearing. The parties are ordered to appear for a review hearing on the ____________ day of ______________, __________, at ____________ (a.m.) (p.m). Failure to appear may result in the issuance of a bench warrant for your arrest or dismissal of this order. Any party ordered to attend counseling shall bring proof of counseling to the review hearing. IT IS FURTHER ORDERED 3: _______________________________________ __________________________________________________________________ __________________________________________________________________. 10. RESPONDENT SHALL NOT CAUSE VIOLATION While this order of protection is in effect, the respondent should refrain from any act that would cause the petitioner to violate this order. This provision is not intended to and does not create a mutual order of protection. Under Section 40-13-6(D) NMSA 1978, only the restrained party can be arrested for violation of this order. 5 11. NOTICE TO LAW ENFORCEMENT AGENCIES ANY LAW ENFORCEMENT OFFICER SHALL USE ANY LAWFUL MEANS TO ENFORCE THIS ORDER. [ ] Petitioner is ordered to surrender all keys to the residence to law enforcement officers. [ ] Law enforcement officers or ________ shall be present during any property exchange. [ ] This order supersedes prior orders in __________________County, State of __________________, Cause No. __________________ to the extent that there are contradictory provisions. 12. NOTICE TO PETITIONER AND RESPONDENT This order does not serve as a divorce and does not permanently resolve child custody or support issues. 13. AGREEMENT OF PARTIES Without admitting that domestic abuse has occurred, the parties stipulate to the entry of this order and affirm that they have read and do understand the effects of this order as stated in Paragraph 2. _______________________________ ___________________________________ Petitioner's signature Respondent's signature _______________________________ ___________________________________ Petitioner's counsel, if any Respondent's counsel, if any _______________________________ ___________________________________ Date Date 14. RECOMMENDATIONS I have: [ ] reviewed the pleading for order of protection; [ ] prepared this order as my recommendation to the district court judge regarding disposition of requests for order of protection. ___________________________________ Signed 6Domestic Violence Commissioner Court's telephone number: _______________ SO ORDERED. __________________________________ District Judge [ ] A copy of this order was [ ] hand delivered [ ] faxed [ ] mailed to [ ] respondent [ ] respondent's counsel on ______________ (date). 4 [ ] A copy of this order was [ ] hand delivered [ ] faxed [ ] mailed to [ ] petitioner [ ] petitioner's counsel on ______________ (date). __________________________________ Signed USE NOTES 1. The first page of this stipulated order of protection form shall be in the uniform format preceding the heading for additional pages of the order. 2. See Form 4-967 NMRA, "Custody, Support and Division of Property Attachment". 3. If appropriate, an order providing for restitution may be included in this paragraph. 4. Petitioner may be served at the time this order is issued. If petitioner is not present at the time this order is issued, service upon petitioner shall be made by delivering a copy to the party. See Section 40-13-6(A) NMSA 1978. [Approved, effective April 9, 2002; as amended by Supreme Court Order 07-8300-20, effective September 17, 2007; as amended by Supreme Court Order No. 08-8300-40, effective December 15, 2008.]