Form 4-968 NMRA. — Application to modify, terminate, or extend the order of protection from domestic abuse.

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

STATE OF NEW MEXICO COUNTY OF _______________ __________________ JUDICIAL DISTRICT COURT

_______________________________, Petitioner

v. No. __________

_______________________________, Respondent

APPLICATION TO MODIFY, TERMINATE, OR EXTEND 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 extend the protection order for an additional____________(days) (months) because: ______________________________________________________________ _____________________________________________________________________.

The other party: [] objects to the extension, modification, or termination of the protection order.

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

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

VERIFICATION

I, the [ ] Petitioner [ ] Respondent, affirm under oath and penalty of perjury under the laws of the State of New Mexico that I am the [ ] Petitioner [ ] Respondent in the aboveentitled cause; that I have read this application to modify, terminate, or extend the order of protection from domestic abuse; and that the contents of the application are true and correct to the best of my information and belief.

________________________________ ________________________________ Date Signature of party filing this application STATE OF NEW MEXICO ) COUNTY OF _____________ ) ss TRIBE OR PUEBLO ______________ )

Signed and sworn before me on this ____ day of _____________, ______. _________________________________ Notary public My commission expires: _______________________.

CERTIFICATE OF SERVICE

I hereby certify that on this ____ day of ______________, ______ this application was

[mailed by United States mail, postage prepaid, and addressed to: Name: _____________________________________________

Address: _____________________________________________

City, State and zip code: __________________________________]

[faxed by ________________________ (name of person who faxed document) to ______________________ (name of recipient) at _________________ (telephone number). The transmission was reported as complete and without error. The time and date of the transmission was ________ (a.m.) (p.m.) on _____________________ (date).]

[e-mailed by __________________________ (name of person who transmitted) to ______________________ (name of recipient) at _________________ (electronic mail address of recipient) who agreed to service in this manner. The transmission was successful. The time and date of the transmission was _________ (a.m.) (p.m.) on _____________________ (date).]

________________________________ Signature of attorney

________________________________ Date of signature

If this notice was served by a person other than an attorney, the following must also be completed and filed with the court:

AFFIDAVIT OF SERVICE

I affirm under penalty of perjury under the laws of the State of New Mexico that a copy of this application was served by [mail] [fax] [electronic transmission] as described above on this ________ day of ______________, __________.

________________________________ Signature of person who made service

[Approved, effective November 1, 1999 until July 1, 2001; approved, effective May 1, 2001; as amended by Supreme Court Order No. 08-8300-40, effective December 15, 2008; by Supreme Court Order No. 12-8300-026, effective for all cases filed or pending on or after January 7, 2013; as amended by Supreme Court Order No. 14-8300-023, effective for all pleadings and papers filed on or after December 31, 2014; as amended by Supreme Court Order No. 15-8300-024, effective for all pleadings and papers filed after November 18, 2015.]