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

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 and/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:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

4. LEGAL ACTION(S) BETWEEN THE RESPONDENT AND ME

The following are legal actions between the Respondent and me. (You may attach additional pages, if

needed)

□ Lawsuit. Please describe: _________________________________________________

□ Complaint. Please describe: _______________________________________________

□ Petition. Please describe: ________________________________________________

□ Restraining Order. Date Issued: ____________ Issued by: ______________________

□ Injunction. Please describe: ______________________________________________

□ Other Legal Action. Please describe: _______________________________________

_________________________________________________________________________

□ None.

5. AFFIDAVIT OF REPORTING PARTY

I, ______________________________________________________________________, hereby swear or affirm that I believe

Reporting Party’s Name

________________________________________________, poses a significant danger of causing

Respondent’s Name

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 Affidavit.

____________________________________

Signature

_________________________________________

Printed Name

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

State of New Mexico

County of __________________________

SIGNED AND SWORN to before me on ____________________________________________

by _________________________________________.

name of person making sworn statement

______________________________

Signature of notarial officer

{Notary Seal}

My Commission Expires:_______________

EXHIBIT A

LAW ENFORCEMENT STATEMENT IN SUPPORT OF A PETITION FOR AN

EXTREME RISK FIREARM PROTECTION ORDER

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: _________________________________________________