N.M. Sup. Ct. Order No. S-1-AO-2025-00009 A

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. My relationship with this person is (please describe your relationship):

___________________________________________________________________________

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

__________________________________________________________________________

street address

__________________________________________________ __________ __________

city state zip

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

HANDGUN LONG GUN

Pistol Revolver Rifle Shotgun

Number _______ Number _______ Number _______ Number ________

Other: (includes any other firearms)

____________________________________________________________________________

____________________________________________________________________________

Number _______

F. Location(s) of firearms: ________________________________________________________

______________________________________________________________________________

G. Does the respondent also have ammunition?  Yes  No  Unknown

H. Location(s) of the ammunition: _________________________________________________

______________________________________________________________________________

2. INFORMATION ABOUT ME (REPORTING PARTY)

A. My full name: ____________________________________________________________

□ The respondent does not know my address and I do not want the respondent to see my

address and contact information.

If you do not want the respondent to know your address and contact

information, do not write it on this form. You must fill out a

Request to Omit Address form so the court knows how to contact

you.

B. My address: _________________________________________________________________

street address

________________________________________________________ _________ _________

city state zip

C. I would like the court to contact me (including receiving notice of court hearings and orders)

at:

 the address I listed above OR

 at the following address:

___________________________________________________________________________

street or P.O. Box

___________________________________________________ __________ __________

city state zip

3. 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:__________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________