4-968
[Standard simplified domestic abuse form,
Family Violence Protection Act,
Sections 40-13-1 to 40-13-8 NMSA 1978.]

________________JUDICIAL DISTRICT COURT
COUNTY OF ___________________________
STATE OF NEW MEXICO

___________________________________________
Petitioner

v.

No. _____________

_______________________________________________
Respondent

APPLICATION TO MODIFY, TERMINATE OR RENEW

THE ORDER OF PROTECTION FROM DOMESTIC ABUSE


[ ] Petitioner [ ] Respondent asks the court:

(check and complete applicable alternatives)

[ ]    to modify the protection order as follows: ____________________________
    ________________________________________________________________.

[ ]    to terminate the protection order because: ____________________________
    ________________________________________________________________.

[ ]    to renew and extend the protection order for an additional _______ (days) (months) because: _______________________________________________
    _________________________________________________________________.

The other party:

[ ]    objects to the renewal, modification or termination of the protection order.

[ ]    agrees to the renewal, modification or termination of the protection order.

[ ]    has not told me whether (he) (she) objects or agrees to the renewal, modification or termination of the protection order.

VERIFICATION


STATE OF NEW MEXICO    }
COUNTY OF ________________    }
TRIBE OR PUEBLO __________    }

The (petitioner) (respondent) was sworn and states: I have read this petition for order of protection from domestic abuse and it is true to the best of my knowledge and belief. I understand that I can be punished both civilly and criminally if any information in this petition is false.

_______________________            __________________________
Date                        Signature of party filing
                        this application

Signed and sworn before me on this ____ day of ____________, ______.

Notary public

_________________________________

My commission expires: _______________________.

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