24 Hour Domestic Violence Hotline 1-800-376-2272
"Peace Begins in the Home"
THIRD JUDICAL DISTRICT COURT
COUNTY OF DOÑA ANA
STATE OF NEW MEXICO
_________________________
Petitioner,
vs.
No. DV 98-___________________
Special Commissioner # _________
________________________
Respondant,
PETITION FOR ORDER PROHIBITING DOMESTIC VIOLENCE
___ We will need an interpreter in_____________to translate at hearings for:
[me]
[the Respondent].
(list language)
INFORMATION ABOUT THE RESPONDENT (the person I am filing against)
1. The Respondent______________________________, is
__ my husband
OR
__ my wife
__ my ex-husband
OR
__ my ex-wife
__ a family member
__ a parent of my child(ren)
__ a household member or former household member
__ a person with whom I have had a continuing personal relationship
describe the relationship ________________________________________________________.
2. The Respondent lives at this address (If on tribal land, please say so). ___________________
______________________________________________________________________________.
3. The Respondent has the following weapons: _______________________________________.
CHILDREN
4. List your or the Respondent's minor children.
| Name
| Date Of Birth
| Age
| Mine
| Respondent
| Ours
|
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
5. List where each of the children are currently living: __________________________________
______________________________________________________________________________.
6. Where and with whom have the children lived for the last three years?
(List separately if did
not live together)_______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________.
7. Does anyone else have physical custody or claim to have custody or visitation
rights? __ yes
__ no. If yes, list the person claiming rights and which child
_____________________________.
OTHER CASES
8. The Respondent and I __ have __ have not been involved in other court cases.
a) There __ is __ is not a divorce case between me and the Respondent.
Is it pending in court? __ yes __ no
b) A New Mexico court or a court in another state has set conditions of child
custody for any
or all of the children listed above. __ yes __ no
c) There is not another Order Prohibiting Domestic Violence pending.
(Fill in if you know: where the other cases(s) are filed: _________________________________
when ____________________ docket number ______________________)
DOMESTIC ABUSE
9. The Respondent committed an act of domestic abuse against me or a member or
my household
on (date) __________________, (time) _______________, (location, indicate which county or
tribal land)._______________________________________________________________________
________________________________________________________________________________.
10. Briefly tell what happened physical abuse (slapping, shoving, hitting, biting,
spitting, etc.)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
threats (verbal, written or telephone threats which caused you to fear that you would be
injured)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
other abuse (damage to your property, threatened harm to your children, stalking, harassment)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
11. Has there been prior abuse? __ yes __ no
12. When the Respondent abused you, had he/she been __ drinking or __ using drugs?
13. Other persons present during the abuse ____________________________________________
________________________________________________________________________________.
14. Were weapons used during the abuse? __ yes __ no If so, what
______________________
________________________________________________________________________________.
REQUESTS TO THE COURT
I REQUEST THE COURT TO MAKE THE FOLLOWING ORDERS (check all which apply)
__a. The Respondent shall not contact me, abuse me and he/she may be ordered
to stay at
least 100 yards from my residence and place of employment or school.
__b. The Respondent shall immediately leave my residence. If the Respondent is not
evicted, I may suffer great injury.
__c. The Respondent shall not sell, remove, pawn, hide, destroy or damage any property
owned by me or the tow of us jointly.
__d. Law Enforcement shall assist me in retrieving my clothing and personal belongings
from the residence at ______________________________________________________________.
__e. Award me temporary possession of our vehicle. (list make/model_________________).
Without this car/truck, I may suffer great injury.
__f. I be given temporary custody of our children and the the Respondent...
( __ have no __ have) contact with them until the
Court hearing.
__g. The Respondent to compensate me for the damage/medical bills he/she caused during
the
abuse (restitution).
__i. Other relief that is necessary to resolve this domestic violence problem (list)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________.
INFORMATION ABOUT THE PETITIONER (me)
__ I DO NOT WANT THE RESPONDENT TO KNOW ABOUT MY ADDRESS, EVEN
AFTER THE 10-DAY HEARING FOR THE FINAL ORDER OR PROTECTION - If so,
please do not fill out this portion. Tell the court clerk, so the he/she may place
your address
under seal.
16. My physical address is _________________________________________________________
in the County/Tribe of ________________________________________, State of New Mexico
My mailing address is _____________________________________________________________
Social Security Number _________________ Date of Birth_______________________________
Phone Number (area code) ( ) _____________________
Work Phone ____________________
Message Phone ________________________
SERVING THE RESPONDENT
17. The Respondent may be found at (physical address) __________________________________
__________________ City __________________ State ___________________ Zip ____________
phone _______________________ His Work address is ___________________________________
_____________________________________His work phone number is ______________________
Social Security Number _____________________ Date of Birth _____________________________
Is the Respondent in jail?
__ yes __ no
VERIFICATION
STATE OF NEW MEXICO
}ss.
COUNTY/TRIBE OF DOÑA ANA
}
The Petitioner was sworn and states: I have ready this
DOMESTIC VIOLENCE PETITION
and it is true to the best of my knowledge and belief. I understand that I can be
punished both
civilly and criminally if this petition is false.
_______________________
_______________________
Date
Signature of Petitioner
Signed and sworn before me on this ______ day of _______________, 1998.
My commission expires:
_______________________
_______________________
Notary Public
The Restraining order up above is only here as a sample of what the real thing looks like.
If you are in need of getting a Restraining order please contact your local Domestic
Violence Shelter, Police Station, and the Municipal Court.
Created on: March 10, 1999
Last Modified:
lacasa@zianet.com
