4-971

STATE OF NEW MEXICO

COUNTY OF _____________________________

__________________ JUDICIAL DISTRICT

No. ______________

__________________________________________

Petitioner

v.

___________________________________________

Respondent

STIPULATED ORDER OF PROTECTION

AGAINST PETITIONER¹

This is not an order of protection under

18 U.S.C. Section 922.

THIS MATTER came before the court upon agreement of the parties to the entry of an order.

The court, having determined that it has legal jurisdiction over the parties and the subject matter, FINDS, CONCLUDES AND ORDERS:

(check only applicable paragraphs)

1.         NOTICE AND APPEARANCES

This order was entered on stipulation of the parties in a proceeding that does not satisfy the requirements of 18 U.S.C. Section 922.²

2.         EFFECT OF STIPULATION TO ORDER OF PROTECTION

Violation of this order can have serious consequences, including:

            A.        If you violate the terms of this order, you may be charged with a misdemeanor, which is punishable by imprisonment of up to 364 days and a fine of up to $1,000.

            B.        You may be found to be in contempt.

            C.        If you are not a citizen of the United States, entry of this order may have a negative effect on your application for residency or citizenship.

3.         DOMESTIC ABUSE PROHIBITED

The petitioner shall not abuse the respondent or members of the respondent's household.

"Abuse" means any incident by petitioner against the respondent or respondent's household member resulting in (1) physical harm; (2) severe emotional distress; (3) bodily injury or assault; (4) a threat by petitioner causing imminent fear of bodily injury to respondent's or respondent's household member; (5) criminal trespass; (6) criminal damage to property; (7) repeatedly driving by respondent's or respondent's household members' residence or work place; (8) telephone harassment; (9) stalking; (10) harassment; or (11) harm or threatened harm to children in any manner set forth above.

Petitioner shall not ask or cause other persons to abuse the respondent or respondent's household members.

4.         CONTACT PROHIBITIONS

Petitioner shall stay _________ yards away from the respondent and the respondent's respondent's home and workplace at all times, unless at a public place, where the petitioner shall remain _________ yards away from the respondent except as specifically permitted by this order.

Petitioner shall not telephone, talk to, visit or contact respondent in any way except as follows:

            [ ]        The parties may contact each other by telephone regarding medical emergencies of minor children;

            [ ]        __________________________________________________________

__________________________________________________________.

            [ ]        The parties may attend joint counseling sessions at the counselor's discretion.

(Unless the court has entered an order sealing respondent's address, include the address of residence and employment for the respondent.)

Petitioner's addresses

            ________________________________        (home address)

            ________________________________        (work address)

            ________________________________        (city)

            ________________________________        (if applicable, tribe or pueblo)

             ________________________________        (state and zip code)

Respondent's addresses:

            ________________________________        (home address)

            ________________________________        (work address)

            ________________________________        (city)

            ________________________________        (if applicable, tribe or pueblo)

             ________________________________        (state and zip code)

5. COUNSELING

            [ ]        Petitioner shall attend and complete counseling at _______________, contacting that office within five (5) days. The petitioner shall participate in, attend and complete counseling as recommended by the named agency.

            [ ]        Respondent shall attend and complete counseling at _______________, contacting that office within five (5) days. The respondent shall participate in, attend and complete counseling as recommended by the named agency.

            [ ]        The petitioner shall report to _____________________ for a [ ] drug [and] [ ] alcohol screen by ______________, ______ (date) with the results returned to this court.

            [ ]        The respondent shall report to _____________________ for a [ ] drug [and] [ ] alcohol screen by ______________, ______ (date) with the results returned to this court.

            [ ]        Other counseling requirements: ________________________________

___________________________________________________________.

6.         CUSTODY³

            [ ]        The court's orders regarding the minor [child] [children] of the parties are found in the Custody, Support and Division of Property Attachment⁴ of this Order of Protection.

7.         PROVISIONS RELATING TO SUPPORT³

            [ ]        The court's orders regarding support issues for the parties are found in the Custody, Support and Division of Property Attachment of this Order of Protection.

8.         PROPERTY, DEBTS, PAYMENTS OF MONEY³

            [ ]        The court's orders regarding property, debts and payment of money are addressed in the Custody, Support and Division of Property Attachment of this Order of Protection.

9.         ADDITIONAL ORDERS

[ ] Review hearing. The parties are ordered to appear for a review hearing on the _____ day of _______________, ________, at _________ (a.m.) (p.m).

Any party ordered to attend counseling shall bring proof of counseling to the review hearing.

IT IS FURTHER ORDERED⁴: ______________________________________

______________________________________________________________

_____________________________________________________________.

10.       RESPONDENT SHALL NOT CAUSE VIOLATION

While this order of protection is in effect, the respondent should refrain from any act that would cause the petitioner to violate this order. This provision is not intended to and does not create a mutual order of protection.

11.       EFFECTIVE DATE OF ORDER; EXTENSION; MODIFICATION

This order is effective upon filing with the clerk of the court.

This order [with the exception of the orders in the Custody, Support and Division of Property Attachment] shall continue until _________________ (date), or until modified or rescinded by the court.

12.       NOT TO BE ENTERED IN FEDERAL REGISTRY

This order shall not be entered into a national domestic violence registry or other national information system.

13.       NOTICE TO LAW ENFORCEMENT AGENCIES

ANY LAW ENFORCEMENT OFFICER SHALL USE ANY LAWFUL MEANS TO ENFORCE THIS ORDER.

            [ ]        Petitioner is ordered to surrender all keys to the residence to law enforcement officers.

            [ ]        Law enforcement officers or ______________________ shall be present during any property exchange.

            [ ]        This order supersedes prior orders in _____________ County, State of ____________, Cause No. _____________________ to the extent that there are contradictory provisions.

14.       NOTICE TO PETITIONER AND RESPONDENT

This order does not serve as a divorce and does not permanently resolve child custody or support issues.

15.       AGREEMENT OF PARTIES

Without admitting that domestic abuse has occurred, the parties stipulate to the entry of this order and affirm that they have read and do understand the affects of this order as stated in Paragraph 2.

            _____________________________              ____________________________

Petitioner's signatureRespondent's signature

            _____________________________              ____________________________

Petitioner's counsel, if anyRespondent's counsel, if any

            _____________________________              ____________________________

DateDate

16.       RECOMMENDATIONS

I have:

            [ ]        reviewed the pleading for order of protection;

            [ ]        prepared this order as my recommendation to the district court judge regarding disposition of requests for order of protection.

________________________________

Signed

Domestic Violence Commissioner

Court's telephone number: ________________

SO ORDERED.

__________________________________________

District Judge

[ ]        A copy of this order was [ ] hand delivered [ ] faxed [ ] mailed to

[ ] respondent [ ] respondent's counsel on __________________ (date).⁵

[ ]        A copy of this order was [ ] hand delivered [ ] faxed [ ] mailed to

[ ] petitioner [ ] petitioner's counsel on __________________ (date).

________________________________

Signed

USE NOTES

1.         This form may be used if the parties stipulate to an order of protection against the petitioner without any findings of abuse.

2.         This order may be entered only upon stipulation of the parties without a hearing on the issue of abuse. If a hearing is held on the issue of abuse, use Form 4-965. If a hearing is held on other matters, Form 4-967 may be attached to this order.

3.         See Form 4-967, "Custody, Support and Division of Property Attachment".

4.         If appropriate, an order providing for restitution may be included in this paragraph.

5.         Petitioner may be served at the time this order is issued. If petitioner is not present at the time this order is issued, service upon petitioner shall be made by delivering a copy to the party. See Section 40-13-6(A) NMSA 1978.

[Effective September 17, 2007.]