Form 4-1001.1 NMRA Law enforcement statement in support of a petition for an extreme risk firearm protection order. | New Mexico Civil Procedure Rules and Forms

Rule text

[Extreme Risk Firearm Protection Order Act, NMSA 1978, Sections 40-17-1 to -13]

STATE OF NEW MEXICO COUNTY OF ________________________ __________________ JUDICIAL DISTRICT

IN THE MATTER OF AN EXTREME RISK FIREARM PROTECTION ORDER FOR _______________________________ __________________ (Respondent's full date of birth)

No. _________________________

LAW ENFORCEMENT STATEMENT IN SUPPORT OF A PETITION FOR AN EXTREME RISK FIREARM PROTECTION ORDER (EXHIBIT A)

1. INFORMATION ABOUT THE PERSON WHO I BELIEVE POSES A SIGNIFICANT DANGER (RESPONDENT) A. The name of the person who I believe poses a significant danger of causing imminent personal injury to self or others by having custody or control or by purchasing, possessing, or receiving a firearm is:

__________________________________________________________________ full legal name

B. Respondent's date of birth: __________________________________________

C. Address of the person (Respondent) who I believe poses a significant danger:

___________________________________________________________________ street address

__________________________________________ __________ __________ city state zip

D. Firearms I believe the Respondent has custody of, controls, owns, or possesses:

Type of Firearm Number Location Ammunition □ Long gun (includes □ Yes □ No rifles and shotguns) □ Unknown □ Handgun (includes □ Yes □ No revolvers and pistols) □ Unknown □ Other (includes any □ Yes □ No other firearms): □ Unknown

TOTAL NUMBER OF RESPONDENT'S FIREARMS: _____________________

2. INFORMATION ABOUT LAW ENFORCEMENT OFFICER COMPLETING STATEMENT

A. Employed by the following type of agency:

 Police Department  District Attorney's Office  Sheriff's Office  Attorney General's Office  State Police

B. Full name: _______________________________________________________

C. Badge/CAID Number _______________________________________________ D. Law Enforcement Agency you work for: ________________________________

E. Law Enforcement Agency address:

___________________________________________________________________ street address

__________________________________________ __________ __________ city state zip

F. Law Enforcement Agency's telephone number: __________________________

3. Description of circumstances under which I collected credible information that gave rise to the petition: (You may attach additional pages, if needed)

________________________________________________________________

________________________________________________________________ 4. Statement of facts I want the court to know: (You may attach additional pages, if needed)

A. Any recent act or threat of violence by the respondent against self or others, regardless of whether the act or threat involved a firearm. Please describe:

________________________________________________________________

B. A pattern of acts or threats of violence by the respondent within the past twelve (12) months, including acts or threats of violence against self or others. Please describe: __________________________________________________

________________________________________________________________

C. The respondent's mental health history. Please describe: _____________

________________________________________________________________

D. The respondent's abuse of □ controlled substances or □ alcohol. Please describe: ________________________________________________________

________________________________________________________________

________________________________________________________________ ________________________________________________________________

E. The respondent's previous violations of any court order. Please describe:

________________________________________________________________

F. Previous extreme risk firearm protection orders issued against the respondent.

Date of Order: _____________ Issued by: ______________________________

G. The respondent's criminal history, including:

arrests and convictions for violent felony offenses. Please describe:

________________________________________________________________

arrests and convictions for violent misdemeanor offenses. Please describe:

________________________________________________________________

arrests and convictions for crimes involving domestic violence or stalking. Please describe: ________________________________________________________

________________________________________________________________

H. The respondent's history of the use, attempted use, or threatened use of physical violence against another person; of stalking another person; or of cruelty to animals. Please describe: ________________________________________________________________

________________________________________________________________

________________________________________________________________ I. Any recent acquisition or attempts at acquisition of a firearm by the respondent. Please describe: ________________________________________________________________

________________________________________________________________

J. In addition, I would like the Court to also consider the following: ________________________________________________________________

________________________________________________________________

5. AFFIDAVIT OF LAW ENFORCEMENT OFFICER

I, ______________________ (Law Enforcement Officer's Name) hereby swear or affirm that I believe _____________________________________________ (Respondent's name), poses a significant danger of causing imminent personal injury to self or others by having custody or control or by purchasing, possessing, or receiving a firearm for the reasons sworn to in this Statement.

____________________________________ Signature ____________________________________ Printed Name

Additional pages are attached to this Affidavit? □ YES □NO

[Adopted by Supreme Court Order No. S-1-RCR-2024-00097, effective for all cases filed on or after December 31, 2025.]

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