New Mexico Forms Library

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.                                                                                                                     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)

                        [ ] a person who has sexually assaulted me

                        [ ] a person who has stalked me

 

            B.        The respondent has the following firearms (make/model): ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

(use additional page if needed)

 

3.         INFORMATION ABOUT [CHILD] [CHILDREN]²

            A.        List minor [child] [children] of either party, even if from another relationship.

 

                                                                        Relationship of [Child] [Children]

Name                         Date of Birth            To You                      To Respondent

_______________  _______________  _______________  _______________

_______________  _______________  _______________  _______________

_______________  _______________  _______________  _______________

_______________  _______________  _______________  _______________

_______________  _______________  _______________  _______________

 

            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]:

 

Child’s name                                   Person claiming rights

________________________      ________________________

________________________      ________________________

 

            E.        Describe how often the [child] [children] have been with the other party during the past six (6) months.

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

 

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                  Case Number           Where Filed

                                    (if known)                   (if known)                   (city and state)

_______________  _______________  _______________  _______________

_______________  _______________  _______________  _______________

 

5.         DOMESTIC ABUSE

            A.        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.        Respondent is a credible threat to my physical safety because: ______________________________________________________________________
_____________________________________________________________________.

            C.        Others present during the abuse: _____________________________________________________________________.

            D.        Did drugs or alcohol play a role in the domestic abuse? [ ] yes [ ] no

            E.        Were weapons used during the abuse? [ ] yes [ ] no

                        If yes, describe the weapons?

            F.         Has there been prior domestic abuse? [ ] yes [ ] no

[continuation sheets to be inserted here]

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 ___________________________________.

            [ ] 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)

            _______________________________________________________________
            _______________________________________________________________.

            [ ] J. the respondent be found to be a credible threat and be required to deliver any firearm in the respondent’s care, custody, or control to a law enforcement officer or a federal firearms licensee.

 

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 NMRA) 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 of __________________, State of New Mexico.

            My mailing address (if different from above):

            ________________________________________

            (street address)

            ________________________________________

            (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.

________________________________ ________________________________

Date                                                                Signature of Petitioner

 

USE NOTES

 

            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. If a child lives with you now, but you do not want the respondent to know your address, do not put your current address here, but do fill out Forms 4-961A and 4-961B NMRA.

 

            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. This form has been approved by the Supreme Court of New Mexico for use in the courts of this state and distribution pursuant to NMSA 1978, Section 40-13-3. Pre-printed pro se forms should include a lined blank page at the end of the form for use by the petitioner if the pre-printed form does not include adequate space for a complete answer to a question.

 

            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; as amended by Supreme Court Order No. 19-8300-009, effective for all petitions filed on or after July 1, 2019.]