4-961A
[For use with 4-961 and 4-972.]
_______________ JUDICIAL DISTRICT COURT
COUNTY OF ___________________________
STATE OF NEW MEXICO

________________________________________
Petitioner

v.        

No. ____________

_________________________________________
Respondent

SERVICE OF PROCESS INFORMATION FOR

PETITION FOR ORDER OF PROTECTION FROM DOMESTIC ABUSE

AND

PETITION FOR EMERGENCY ORDER OF PROTECTION1


INFORMATION ABOUT THE RESPONDENT

    _________________________________
    Respondent's name

    _________________________________
    Respondent's date of birth

    _________________________________
    Respondent's social security number

    Is respondent in jail? [ ] yes [ ] no
    If yes, where? __________________________________

    Respondent's physical address is:

    ________________________________ (street)

    ________________________________ (city)

    ________________________________ (county)

    ________________________________ (state and zip code)


    [ ] Tribe [ ] Pueblo of _______________________

    Respondent's workplace:

    ________________________________ (employer's name)

    ________________________________ (street)

    ________________________________ (city)

    ________________________________ (county)

    ________________________________ (state and zip code)

    [ ] Tribe [ ] Pueblo of __________________

    Respondent works the following hours:
    __________ (a.m.) (p.m.) to __________ (a.m.) (p.m.)

    What does respondent look like?
    Hair _________ (color)    Eyes _________ (color)
    Height __________        Weight __________
    Race -- ethnicity: _________________________________
    Other physical characteristics or marks: ____________________________
    ________________________________________________________________.

    Do you consider the respondent to be dangerous?
    [ ] yes [ ] no If yes, why? _____________________________________
    _____________________________________________________________.

    Does respondent have any weapons? [ ] yes [ ] no
    If yes, please describe: _______________________________.

    Places where respondent can be found apart from physical address and workplace: ________________________________________________
    __________________________________________________________.

___________________        ______________________________
Date                    Signature of petitioner

                    _______________________________________
                    (Petitioner's street address

                    unless petitioner files Form 4-961B)

                    _______________________________________
                    (City, state and zip code
                    unless petitioner files Form 4-961B)

USE NOTE

    1.    This form should be used with Form 4-961 (Petition for Order of Protection from Domestic Abuse) and Form 4-972 (Petition for Emergency Order of Protection from Domestic Abuse). It should be distributed to pro se petitioners pursuant to Section 40-13-3 NMSA 1978. This use note need not be printed on pre-printed pro se forms.

[Approved, effective November 1, 1999 until July 1, 2001; approved, effective May 1, 2001.]