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ProTechMe NMLA (read top first, then middle-right, then bottom) (split 1…

- - - - What is your name?
- - - - What is your request for the court? (Multiple Choice: check all that apply)
        
        Do you believe irreparable harm would result if you told
        the respondent that you are filing a petition before coming to court?
        
        No--I have told the respondent that I'm filing this petition.
        
        That's good to hear. Please provide some information about the respondent. What is their address, city, state, and zip code?
        
        What is their work telephone number?
        
        What is their work address?
        
        What is their home telephone number?
        
        What is the respondent's date of birth?
        
        If they live in Indian Country, please name their tribe or pueblo.
        
        Is the respondent in jail? (Y/N)
        
        VERIFICATION/ USE NOTE: You will still need to sign the forms that are filled out using this information and affirm that you are telling the truth.
        
        Yes: Please 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.
        
        Do you want your information to be kept confidential?
        
        No.
        
        Please provide your home telephone number or write "N" to skip.
        
        Please provide your mobile telephone number or write "N" to skip.
        
        Please provide your work telephone number or write "N" to skip.
        
        What is your mailing address? (street address followed by city and zip code)
        
        What is your physical address?
        
        Is it in the County or in Indian Country?
        
        A: County
        
        A: Indian Country.
        
        1 more item...
        
        Yes. I do not want the respondent to know my address now or after the hearing for the final order of protection.
        
        (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.)
        
        For 4_961b
        
        SIGNATURE, DATE, ADDRESS, USE NOTE, ETC
        
        I do not want my current address and telephone number to be made known to the respondent for the following reasons:
        
        My current address is: (address, city, state, and zip code)
        
        What is your home telephone number?
        
        What is your work telephone number?
        
        What is your mobile telephone number?
        
        You will still need to sign the forms that can be filled out with this information. By doing so, you: 3. I ask the court not to disclose my current address and telephone number.
        
        I ask that if my request is granted, all process and papers be served on me by delivering
        them to the clerk of the court who shall serve me at my current address.
        
        I agree that if either my address or telephone number change during this lawsuit, I will
        immediately file another form like this one giving my new address or telephone number.
        
        For 4_961a
        
        SIGNATURE, DATE, ADDRESS, USE NOTE, ETC
        
        Where can the respondent be found besides their physical address and workplace?
        
        Does the respondent have any weapons?
        
        1 more item...
        
        Do you consider the respondent to be dangerous? (Y/N)
        
        1 more item...
        
        What other physical characteristics or marks does the respondent have?
        
        What is the respondent's race/ethnicity?
        
        What is the respondent's weight?
        
        What is the respondent's height?
        
        What is the respondent's eye color?
        
        What is the respondent's hair color?
        
        What is the respondent's mobile telephone number?
        
        What is the respondent's work telephone number?
        
        What is the respondent's home telephone number?
        
        What hours does the respondent work? (please give a range in a.m./p.m. - a.m./p.m.
        
        Do they live in a tribe or pueblo? (MC)
        
        1 more item...
        
        What is their employer's address? (street, city, county state, and zip code)
        
        Who is their employer?
        
        What is the respondent's physical address? (street, city, county, state)
        
        1 more item...
        
        Is the respondent in jail? (Y/N)
        
        1 more item...
        
        What is their date of birth?
        
        What is the respondent's name?
        
        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. (1) that until the court hearing: [ ] respondent shall have the following contact with the [child] [children]: __.
        F. (2) that until the court hearing: [ ] respondent shall have no contact with the [child] [children].
        G. (1) that the respondent shall pay: [ ] support for the [child] [children]
        G. (2) that the respondent shall pay:
        [ ] 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 stop the abuse (list or describe what relief is necessary):
        __.
    - - THE COURT IS REQUESTED TO ENTER AN EMERGENCY ORDER OF
        PROTECTION prohibiting respondent from abusing petitioner or any member of petitioner's
        household as follows:
        (check applicable)
        [ ] providing for law enforcement officers to assist [ ] petitioner [ ] respondent in
        retrieving [ ] petitioner's [ ] respondent's clothing and personal belongings from
        the residence at __.
        [ ] granting petitioner temporary custody of the child(ren) listed in this petition.
        [ ] prohibiting respondent from contact with the child(ren) listed in this petition.
        [ ] other relief that is necessary to stop abuse (list or
        describe what relief is necessary):
        
        1[ ] --residence at__.
        
        4[ ] --Please describe what relief is necessary.
        
        Do you want your information to be kept confidential?
        
        No.
        
        Please provide your home telephone number or write "N" to skip.
        
        Please provide your mobile telephone number or write "N" to skip.
        
        Please provide your work telephone number or write "N" to skip.
        
        What is your mailing address? (street address followed by city and zip code)
        
        What is your physical address?
        
        Is it in the County or in Indian Country?
        
        A: County
        
        A: Indian Country.
        
        1 more item...
        
        Yes. I do not want the respondent to know my address now or after the hearing for the final order of protection.
        
        (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 another form (Form 4-961B NMRA) for your name and address and request that the clerk place your address under seal.)
        
        For 4_961b
        
        SIGNATURE, DATE, ADDRESS, USE NOTE, ETC
        
        I do not want my current address and telephone number to be made known to the respondent for the following reasons:
        
        My current address is: (address, city, state, and zip code)
        
        What is your home telephone number?
        
        What is your work telephone number?
        
        What is your mobile telephone number?
        
        You will still need to sign the forms that can be filled out with this information. By doing so, you: 3. I ask the court not to disclose my current address and telephone number.
        
        I ask that if my request is granted, all process and papers be served on me by delivering
        them to the clerk of the court who shall serve me at my current address.
        
        I agree that if either my address or telephone number change during this lawsuit, I will
        immediately file another form like this one giving my new address or telephone number.
        
        Please provide some information about the respondent. What is their address, city, state, and zip code?
        
        7 more items...
- - - - If the person you need protection from has any weapons, please list them in a reply separated by commas.
        
        Are there any children that are under the guardianship of you or the person you need protection from?
        
        What is your relationship to the first child? (parent or guardian)
        
        What is the respondent's relationship to the first child? (parent or guardian)
        
        What is the name of the first child?
        
        What is the date of birth of the first child?
        
        Is there a _ child that is under the guardianship of you or the person you need protection from?
        
        What is your relationship to the _ child? (parent or guardian)
        
        What is the respondent's relationship to the _ child? (parent or guardian)
        
        What is the name of the _ child?
        
        What is the date of birth of the _ child?
        
        Please list the address at which and the person with whom the _ child currently lives. (If any child does not reside with the same person, please list separately)
        
        Please list the address at which and the person with whom the _ child has lived for the past five years. (If any child does not reside with the same person, please list separately)
        
        Does anyone have physical custody of the first child or claim to have custody or visitation rights?
        
        What is the name of the person claiming rights of the first child?
        
        Please list the address at which and the person with whom each child currently lives. (If any child does not reside with the same person, please list separately)
        
        Please list the address at which and the person with whom each child has lived for the past five years. (If any child does not reside with the same person, please list separately)
        
        Have any divorce, separation, order of protection, child support, paternity, abuse or neglect cases been previously filed by you, the person you need protection from, or the government?
        
        What was the case number? or [I don't know]
        
        Where was the case filed? (city and state)
        
        Have any divorce, separation, order of protection, child support, paternity, abuse or neglect cases been previously filed by you, the respondent or the government?
        
        4 more items...
        
        Did the person you need protection from commit physical abuse against you or a member of your household?
        
        7 more items...
        
        In what year was the case filed? or [I don't know]
        
        What type was the first case?
        
        Please list the address at which and the person with whom the first child currently lives. (If any child does not reside with the same person, please list separately)
        
        Please list the address at which and the person with whom the first child has lived for the past five years. (If any child does not reside with the same person, please list separately)
        
        Does anyone have physical custody of the first child or claim to have custody or visitation rights?
        
        What is the name of the person claiming rights of the first child?
      - Please describe your family relationship with the person you need protection from.
      - Please describe the continuing personal relationship you've had with the person you need protection from.