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

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street address

________________________________________________ ____________ __________

city state zip

E. 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

□ Yes □ No

□ Handgun (includes □ Unknown

revolvers and pistols)

□ 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)

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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: _________________________

___________________________________________________________________________

___________________________________________________________________________

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B. A pattern of acts or threats of violence by the respondent within the past twelve months,

including acts or threats of violence against self or others. Please describe:

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C. The respondent’s mental health history. Please describe: _______________________

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