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Petition For Order Of Protection From Domestic Abuse 4-961 - New Mexico

Petition For Order Of Protection From Domestic Abuse Form. This is a New Mexico form and can be used in Domestic Violence 3rd Judicial District Local District Court .
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STATE OF NEW MEXICO COUNTY OF DONA ANA THIRD JUDICIAL DISTRICT COURT , Petitioner, v. No. DV Judge: , Respondent. PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE (PETITIONER SHOULD COMPLETE ALL INFORMATION KNOWN BY THE PETITIONER) 1. COURT ASSISTANCE REQUEST: We will need an interpreter in hearings for: me the respondent. We will need (describe other request for special help): to translate at 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 PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 10 B. The respondent has the following weapons: 3. [CHILD] [CHILDREN] This part must be completed if there are children. Section 40-10A-209 NMSA 1978 of the Uniform Child-Custody Jurisdiction Enforcement Act requires the first pleading of every custody action to give information under oath 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 RESPONDENT TO KNOW YOUR ADDRESS, DO NOT PUT YOUR CURRENT ADDRESS HERE, BUT DO FILL OUT FORMS 4-961A AND 4-961B. A. List minor [child] [children] of either party. NAM E DATE OF BIRTH RELATIONSHIP OF [CHILD] [CHILDREN] 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.) PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 10 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 NAM E PERSON CLAIM ING 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 NUM BER (if known) W HERE FILED (city & 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.) Date of abuse: Place of abuse: . . PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 10 Physical abuse: Threats which caused fear that you or any household member would be injured: Other abuse: . B. Others present during the abuse: . C. Did drugs or alcohol play a role in the domestic abuse? YES NO PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 10 D. Were weapons used during the abuse? If yes, what weapons? YES NO . 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]. (1) that the respondent shall immediately leave my our residence at: B. . 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. PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 10 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 describe what relief is necessary): (list or . (Turn to page 7) PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 10 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 of New Mexico. State of My mailing address is: (street address) (city & zip) My telephone numbers are: HOM E W ORK M ESSAGE C. My date of birth is: PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE D istrict C ourt C ivil Form (4-961) effective D ecem ber 15, 2008 (rev. 06/09, 03/10) American LegalNet, Inc. www.FormsWorkFlow.com Page 7 of 10 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
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