WPC  &8pc$Aoi񱻟m b`Py)ٷ{$"%13ZVݿSFͥ9$Ɇ@&Ĝ#L$F82'˩h j\ᄬO8޲ذ\w{*%uC>5I!hO[/KK{;աs1M a# D0rof}i>o|)f]M1jɼ"ݭ\K|ќح-1f~w/3RKxwi۝*uy 䆍;/-(\mb-fFww >^#Ǡ v]泵oXf!xsCA.&k`yx\(M+Frέ\&&H6)Ϊ16ߕ4 çB&^׺ _Z&\\Q h-6QdϚ y(U_cލ]*ܹ&G&gMl6kRg]AValb?J Bg#!U N % 0( U>? 1u}  ^  w@ 4T h w my  N 0c 1 1 1 Dell Laser Printer 1720dn0(9 Z6Times New Roman RegularX($%\  `&Times New Roman3#37=CIQYag1.a.i.(1)(a)(i)1)a)    ó%: }U~UUUUUAUg7:i+003|x U  X (;3$2#  0  .3  0  (EGMSY_ekqAutoList19A.A.A.A.A.A.A.A.(jEGMSY_ekqAutoList20A.A.A.A.A.A.A.A.(%EGMSY_ekqAutoList211.1.1.1.1.1.1.1. !  _ LXtwXXX!XXtw/V_DISTRICTCOURTCIVIL0  0h(#(#0h(#h(#0(#(#0p(#(#SupremeCourtApprovedp(#p(# 49610   `     h      p 0(#(#October29,20080 (#(#0@ x(#x(#0@ x(#x(#0@ x(#x(#0@ x(#x(#0@ x(#x(##XtwX!l##XtwXXXtwM#v (# (# FIRSTJUDICIALDISTRICTCOURTSTATEOFNEWMEXICOCOUNTYOF   P    `     h   CaseNo.:D_________________________   `     h      p   XtwXXXtẁ______________________________,Petitionerv.0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(# (#(# ______________________________,̀Respondent  0 @4 @ PETITIONFORORDEROFPROTECTION L 0 @4 @ FROMDOMESTICABUSE1 8  @Ӏ $  1.  COURTASSISTANCEREQUEST     []0 ` Wewillneedaninterpreterin__________________totranslateathearingsfor  []me[]therespondent. ` (#` (#   [] ` Wewillneed__________________(describeotherrequestforspecialhelp). \  2.  INFORMATIONABOUTTHERESPONDENT (thepersonIamfilingagainst)   4 Ѐ  A. ` Therespondentis: h   ` Ѐ   ` [] myhusbandor[]mywife    L Ѐ   ` [] myex-husbandor[]myex-wife p  !8  Ѐ   ` [] theparentofmy[child][children] p  "$!    ` [] afamilymember__________________________________ #"    `  (describethefamilyrelationship) p  $# 0  0` (#(#0 ` (#` (# ` [] apersonwithwhomIhavehadacontinuingpersonalrelationship % $ ________________________________________(describethe &!% relationship)p'"& (# (#    ` [] apersonwhohassexuallyassaultedme \(#'    ` [] apersonwhohasstalkedme H)$( ̀  B. ` Therespondenthasthefollowingweapons:_________________________  +p&* Ѐ#XtwXXXtw#ԀRCRNo.65XtwXXXtw0 0 (# (#0h(#(#0h(#h(#0(#(#1/ +/(#(#  3.  [CHILD][CHILDREN]2󀀀     A. ` Listminor[child][children]ofeitherparty.     Name0 ` 0 ` (#` (#0 (# (#Dateof  0(#(#Relationshipof[Child][Children] @ `(#(# 0   `  0(#(#Birth h 0(#(#0(#(#ToYou    ToRespondent @! L (#(#  0  ______________  _____________  _____________  _____________ @!  (#(#    `     8    _______________  ______________  ______________  ______________       _______________  ______________  ______________  ______________        _______________  ______________  ______________  ______________8    0  0` (#(#  B. ` Listaddressandwithwhomthe[child][children]arecurrentlyliving.(Listeach ^  childseparatelyif[child][children]donotresidewithsameperson.) J  _____________________________________________________________ ` (#` (#    ` ____________________________________________________________#X XXX 9 #0  0` (#(#  C. ` Listeachaddresswhere[child][children]havelivedduringthelastfive(5)years. J (Listeachchildseparatelyif[child][children]didnotresidewithsameperson.) 6  ` (#` (#   0 ` 0 ` (#` (# ` ____________________________________________________________  (# (#    ` ____________________________________________________________0  0` (#(#  D. ` Doesanyoneelsehavephysicalcustodyofthe[child][children]orclaimtohave  custodyorvisitationrights?[]yes[]no ` (#` (#    ` Ifyes,completethefollowingforthe[child][children]: Z     ` Child'sname  h 0  0(#(# Personclaimingrights x F(#(# 0  0` (#(#________________________  ______________________ x   6 ________________________  _______________________ "r` (#` (# Ѐ 4.  OTHERCASES  J    []0 ` Thefollowingdivorce,separation,orderofprotection,childsupport,paternity, 6! abuseorneglectcaseshavebeenpreviouslyfiledbyme,therespondentorthestate: ` (#` (#    TypeofCase0 0 (# (#YearFiled0(#(#0(#(#CaseNumber0 (#(#WhereFiled "$ (# (#    `     h (ifknown)  (ifknown)(cityandstate) x  #% Ѐ______________  ______________  ______________  ______________ $&   ______________  ______________  ______________  ____________ n% '   ______________  ______________  ______________  ______________ Z&!(   5.  DOMESTICABUSE  2(#* L d(3L S     S%2  A  .3  0 `   Therespondentcommittedthefollowingact(s)ofdomesticabuseagainstmeora )n$+ memberofmyhousehold:(describeindetailwhathappenedtoyouortoa  *Z%, memberofyourhouseholdandwhenandwhere.)S%\݌*F&-` (#` (# Ќ     ` Physicalabuse: _________________________________________________ +2'. 0  0` (#(#_____________________________________________________________. ` (#` (#  0  0` (#(# ` (#` (#  󀀀_RCR_ԀNo.65X XXX 0 0 (# (#0h(#(#0h(#h(#2#X XXX F!# /*2(#(# /V X   0  0` (#(#Threatswhichcausedfearthatyouoranyhouseholdmemberwouldbeinjured:___________________________________________________________ ` (#` (# 0  0` (#(#Otherabuse: __________________________________________________ t _____________________________________________________________. ` (#` (#    ` Dateofabuse:________________________________________________. P     ` Placeofabuse:_______________________________________________.  <    B. ` Otherspresentduringtheabuse:___________________________________. ( x   C. ` Diddrugsoralcoholplayaroleinthedomesticabuse?[]yes[]no  P    D. ` Wereweaponsusedduringtheabuse?[]yes[]no (     ` Ifyes,whatweapons?____________________________.  E. ` Hastherebeenpriordomesticabuse?[]yes[]no    6.  REQUESTSTOTHECOURT  t   IREQUESTTHATTHECOURTORDER(checkallthatyouwant): L ̀  [] ` A.0 thattherespondentnotcontactme,notabusemeandthattherespondent $t stayawayfrommyresidence[and][placeofemployment][and][school].  (# (# ̀  [] ` B.(1)thattherespondentshallimmediatelyleave[]my[]ourresidence 8    `  at____________________________________________. x   $   ̀  [] ` 0 (2)thattherespondentprovidemewithtemporarysuitablealternative  housing. h  (# (#    `     h     ̀  [] ` C.0 thattherespondentshallnotsell,remove,pawn,hide,destroyordamage p anypropertyownedbymeorthetwoofusjointly. x \  (# (# ̀  [] ` D.0 thatlawenforcementofficersassistmeinretrievingmyclothingand 4"  personalbelongingsfromtheresidenceat________________________________________________________________.  (# (# ̀  [] ` E.0 thatIbegiventemporarycustodyofthe[child][children]listedinthis %4!$ petition. h & "% (# (# ̀  [] ` F.0 thatuntilthecourthearing:  (#' (# (# ̀   ` 0 []  respondentshallhavethefollowingcontactwiththe[child]*%) (# (#    `    [children]:________________________________________.̀   `  []0  respondentshallhavenocontactwiththe[child][children].D-(,(#(# _RCR_ԀNo.65X XXX 0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#3#X XXX V/#0X+/(#(# L  X   р  [] ` G. thattherespondentshallpay: p      `  []  supportforthe[child][children]    ̀   `  []  supportforme.   t ̀  [] ` H.0 thattherespondentshallpaymeforthedamageandmedicalbillsresulting L  fromtheabuse.  8  (# (# ̀  [] ` I.0 otherreliefthatisnecessarytoresolvethisdomesticabuseproblem(list  ` ordescribewhatreliefisnecessary): L  (# (#   0 ` 0 ` (#` (#______________________________________________________  8  ___________________________________________________.  (# (#  7.  INFORMATIONABOUTTHEPETITIONER(ME)      (Ifyoudonotwanttherespondenttoknowyouraddressandphonenumber,donot   includeitonthisform.Tellthecourtclerkthatyouneedtocompletetwootherforms(Forms4-961Aand4-961B)foryournameandaddressandrequestthattheclerkplaceyouraddressunderseal.) \ Ѐ  [] ` A.0 IDONOTWANTRESPONDENTTOKNOWMYADDRESSNOW 4 ORAFTERTHEHEARINGFORTHEFINALORDEROFPROTECTION.IHAVECOMPLETEDFORM4-961BANDGIVENITTOTHECOURTCLERK. p L (# (#    0 ` OR 8` (#` (#   [] ` B.0 Myphysicaladdressis:____________________________________  _________________________________inthe[]County[]IndianCountryof__________________,StateofNewMexico.  (# (#    `  Mymailingaddressis:   `  __________________________________________(streetaddress) \     `  ____________________________________________(cityandzip) H!     `  Mytelephonenumbersare:  #p!    `  Home  0 h 0h(#h(#Work  0p(#(#0p(#p(#Message x $H #(#(#    `  _________________  _________________  __________________  %4!$ 8.  NOTICETORESPONDENT  ' #&   [] ` A.0 IhavenottoldrespondentthatIamfilingapetitiontoaskthecourtforan )$( orderofprotectionbecauseIbelieveirreparableharmwouldresultifItoldrespondentbeforecomingtocourt.(Describewhatmighthappentoyou l+&* orwhatyouareafraidmighthappeniftherespondentknewyouwereaskingforacourtorderofprotection.)____________________________ @#  D-(, ____________________________________________________________  (# (# ̀_RCR_ԀNo.65X XXX 0 0 (# (#0h(#(#0h(#h(#4#X XXX =#Ԁ0X+/(#(#   [] ` B. IhavetoldrespondentthatIamfilingthispetition. x    9.  LOCATIONOFRESPONDENT  t L ej((dL S     Sƪ?2j  A  .3  0 `   Respondentmaybefoundat:Sƪ??݌`` (#` (# Ќ     ` ______________________________(address) L     ` ______________________________(city) 8     ` ______________________________(stateandzipcode) $ t 0  0` (#(#______________________________(ifinIndianCountry,pleasenametribeor  ` pueblo). L ` (#` (#    ` Respondent's:   ` ______________________________(dateofbirth) $     ` ______________________________(hometelephonenumber)      ` ______________________________(workaddress)      ` ______________________________(worktelephonenumber).     S     S:D2j  B  .3  0 `   Isrespondentinjail?[]yes[]noS:DqD݌p` (#` (# Ќ  @# VERIFICATION  H STATEOFNEWMEXICO   h 0  }  4(#(# COUNTYOF_________________0 h 0h(#h(#} p(#(# TRIBEORPUEBLO______________0  } \(#(# Thepetitionerwasswornandstates:I,thePetitioner,beingdulyswornuponmyoath,depose 4 andstatethatIamthePetitionerintheaboveentitledcauseandIhavereadthepetitionfororder   ofprotectionfromdomesticabuse .Istatethatthecontentsthereofaretrueandcorrecttothe   bestofmyinformationandbelief.  Ѐ_____________________0  0h(#(#0h(#h(#___________________________________(#(# Date   `  0  0h(#(#0h(#h(#SignatureofPetitionerl(#(# ЀSignedandswornbeforemeonthis________dayof______________,__________.  Notarypublic  ______________________________  Mycommissionexpires:______________________________.̀_RCR_ԀNo.65X XXX 0 0 (# (#0h(#(#0h(#h(#5#X XXX }J#0T+/(#(# Ї@% USENOTES   1.  Petitionershouldcompleteallinformationknownbythepetitioner.  L f%((eL S   S8L2%  2  .3  0    Thispartmustbecompletediftherearechildren.Section40-10A-209_NMSA_Ԁ1978of  theUniformChild-CustodyJurisdictionEnforcementActrequiresthefirstpleadingofeverycustodyactiontogiveinformationunderoathastothechild'spresentaddress,theplaceswherethechildhaslivedwithinthelastfive(5)yearsandthenamesandpresentaddressesofthepersonswithwhomthechildhaslivedduringthatperiod.Ifachildliveswithyounow,butyoudonotwantrespondenttoknowyouraddress,donotputyourcurrentaddresshere,butdofilloutForms4-961Aand4-961B.S8LcL݌ (#(# Ќ   S   S|O2%  3  .3  0    UseNotes1and2aretobeprintedonpre-printedformspublishedforusebyprose  L  petitioners.ThisnoteandUseNote4shouldnotbeprintedontheform.ThisformhasbeenapprovedbytheSupremeCourtofNewMexicoforuseinthecourtsofthisstateanddistributionpursuanttoSection40-13-3_NMSA_Ԁ1978.Pre-printedproseformsshouldincludealinedblankpageattheendoftheformforusebythepetitionerifthepre-printedformdoesnotincludeadequatespaceforacompleteanswertoaquestion.S|OO݌ (#(# Ќ   S   SuR2%  4  .3  0    Section40-13-3.1(A)(4)_NMSA_Ԁ1978providesthatavictiminadomesticabusecase   shallnotberequiredtopayforSuRR݌ (#(# Ќ  [Approved,effectiveNovember1,1999untilJuly1,2001;approved,asamended,effectiveMay1,2001;asamended,effectiveFebruary16,2004;asamendedbySupremeCourtOrderNo.08 H 830040,effectiveDecember15,2008.] 4 ̀_RCR_ԀNo.65X XXX 0 0 (# (#0h(#(#0h(#h(#0(#(#6#X XXX ;U#0T+/(#(#  X XXX 4963.   ` 0 0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#SupremeCourtApprovedp(#p(#    `     h      p October29,2008   `     h      p   FIRSTJUDICIALDISTRICTCOURTCOUNTYOFSANTAFESTATEOFNEWMEXICO   `     h      p    `     h CaseNo.:D0101_DV_Ԅ0200800 x    `    `   7YPetitioner@* $     `  v.   ` 0 0 (# (#0h(#(#0h(#h(#0(#(# (#(# @* Respondent `     p   Z@  TEMPORARYORDEROFPROTECTION 4 @<<!ANDORDERTOAPPEAR   p Thecourthasreviewedtheswornpetitionallegingdomesticabuse.Thecourthavingconsideredthepetition, FINDS thatthecourthasjurisdiction,andthatthereisprobablecausetobelieve 4 thatanactofdomesticabusehasoccurred.Thecourt ORDERS : $ [ ]0  1.0` (#(#Respondentshallnotwriteto,talkto,visitorcontactthepetitionerinanyway  exceptthroughpetitioner'slawyer,ifpetitionerhasalawyer. ` (#` (# [ ]0  2.0` (#(#Respondentshallnotabusethepetitionerorthepetitioner'shouseholdmembersin x anyway."Abuse"meansanyincidentbyrespondentagainstpetitioneroranotherhouseholdmemberresultingin(1)physicalharm;(2)severeemotionaldistress;(3)bodilyinjuryorassault;(4)athreatcausingimminentfearofbodilyinjury;(5)criminaltrespass;(6)criminaldamagetoproperty;(7)repeatedlydrivingbyaresidenceorworkplace;(8)telephoneharassment;(9)stalking;(10)harassment;(11)harmorthreatenedharmtochildreninanymannersetforthabove; ` (#` (# [ ]0  3.0` (#(#Respondentshallnotaskorcauseotherpersonstoabusethepetitionerorthe &,"% petitioner'shouseholdmembers. ` (#` (# [ ]0  4.0` (#(#Respondentshallnotgowithin 100 yardsofthepetitioner'shomeorschoolor )$( workplace.Respondentshallnotgowithin 100 yardsofthepet_i_Ԁt_i_Ԁoner *%) _a_Ԁtal_l_Ԁt_i_Ԁmesexcept_____________________ ` (#` (# 0  0` (#(#________________________________.Ifatapublicplace,suchasa ` (#` (#     _RCR_ԀNo.65̀0  0` (#(#store,respondentshallnotgowithin 50 yardsofpetitioner.  4/*.` (#` (#  $0t+/ Ї[ ]0  5.0` (#(# _shallhavetemporaryphysicalcustodyofthefollowingchild(_ren_):` (#` (# 0  0` (#(#______________ _______________________` (#` (# 0  0` (#(#________________________________________________________. ` (#` (# [ ]  6.0 ` Withrespecttothechild(_ren_)namedintheprecedingparagraph,`` (#` (# 0  0` (#(#[ ]respondent[]petitionershallhave:L ` (#` (# 0  0` (#(#[ ]0 ` (#` (#A.  Nocontactwiththechild(_ren_)untilfurtherorderofthiscourtand $ t shallstay_100__yardsawayfromthechild(_ren_)'sschool.  (# (# 0  0` (#(#[]0 ` (#` (#B.  Contactwiththechild(_ren_),subjectto: 8  (# (# 0  0` (#(#0 ` (#` (#______________________________________________  (# (# 0  0` (#(#0 ` (#` (#______________________________________________  (# (# 0  0` (#(#0 ` (#` (#______________________________________________.  (# (# [ ]  7.0 ` Neitherpartyshallremovethechild(_ren_)namedintheprecedingparagraphfrom   theStateofNewMexicoor_disenroll_Ԁthechild(_ren_)fromthechild(_ren_)spresentschoolduringtheperiodofthistemporaryorderofprotection.`` (#` (# [ ]  8.0 ` Thecourtmaydecidetemporarychildandinterimsupportatthehearing8` (#` (# 0  0` (#(#listedbelow.Bothpartiesshallbringtothehearingproofofincomeintheformofthetwolatestpaystubsorthefederaltaxreturnsfromthepreviousyear,proofofworkrelateddaycarecostsandproofofmedicalinsurancecostsforthechild(_ren_) ` (#` (# []0  9.(#(# 0  0` (#(#[ ]0 ` (#` (#A.  Respondentisorderedtoimmediatelyleavetheresidenceat  ____________________________________________,andtonotreturnuntilfurthercourtorder.  (# (#   0 ` [ ]0 ` (#` (#B.  Lawenforcementofficersareherebyorderedtoevictrespondent H! fromtheresidenceat____  (# (# 0  0` (#(#0 ` (#` (#___________________________________________________.  (# (# 0  0` (#(#[ ]0 ` (#` (#C.  Respondentisorderedtosurrenderallkeystotheresidencetolaw $H # enforcementofficers.  (# (#    ` _RCR_ԀNo.65[]0  10.0` (#(#Lawenforcementofficersorshallaccompany[]respondent[]petitionerto l+&* removeessentialtools(asspecifiedinNo.13), clothing,andpersonalbelongings X,'+ fromtheresidenceat H-(,` (#` (# [ ]0  11.0` (#(#Neitherpartyshalltransfer,hide,adddebtto,sellorotherwisedisposeofthe  /p*. other'spropertyorthejointpropertyofthepartiesexceptintheusualcourseof 0`+/ businessorforthenecessitiesoflife.Thepartiesshallaccounttothecourtforallsuchchangestopropertymadeaftertheorderisservedorcommunicatedtotheparty.Neitherpartyshalldisconnecttheutilitiesoftheotherparty'sresidence. ` (#` (# [ ]0  12.0` (#(#ThisordersupersedesanyinconsistentpriororderinCauseNo. ` _________________andanyotherpriordomesticrelationsorderanddomesticviolencerestrainingordersbetweenthesetwoparties. ` (#` (# [ ]0  13. ` Other: d(#(# 0  0` (#(#_________________________________________________________ ` (#` (# 0  0` (#(#_________________________________________________________ ` (#` (# 0  0` (#(#________________________________________________________. ` (#` (# []0  Whilethisorderofprotectionisineffect,petitionershouldrefrainfromanyactthat   wouldcasetherespondenttoviolatethisorder.Thisprovisionisnotintendedtoanddoesnotcreateamutualorderofprotection..UnderSection40126(D)_NMSA_Ԁ1978,   onlytherestrainedpartycanbearrestedforviolationofthisorder. (#(# [ X ]0  14.0` (#(#P` (#` (# .  HEARING  ,| 0  ITISFURTHERORDEREDthatthepartiesshallappearinthe FirstJudicialDistrict X Court,attheCornerof_Catron_ԀandGrant,SantaFe,NewMexico,Room250,beforeMARGARETKEGELDomesticRelationsHearingOfficerat______(a.m)(p.m.)on_______________,z_______z forhearingonwhetheranextendedorderof   protectionagainstdomesticabusewillbeissued.Eitherpartymaybringwitnessesorevidenceandmayberepresentedbycounselatthishearing.RespondentmayfileaResponsetothePetitionforOrderofProtectionfromDomesticAbuse,seeForm4962  _NMRA_,onorbeforethehearing.Iftherespondentfailstoattendthishearing,an  extendedordermaybeenteredbydefaultagainstrespondentandabenchwarrantmaybeissuedforrespondent'sarrest.Ifpetitionerwillfullyfailstoappearatthishearing,thepetitionmaybedismissed.Thisorderremainsinforceuntil ________________,_____. H" (#(# |  |{RCRNo.65{|| }}[ X ]0  DONOTBRINGANYCHILDRENTOTHEHEARINGWITHOUTPRIOR %L!$ PERMISSIONOFTHECOURT. &<"%(#(#    ENFORCEMENTOFORDER ($'  0  Iftherespondentviolatesanypartofthisorder,therespondentmaybechargedwitha *%) crime,arrested,heldincontemptofcourt,finedorjailed. (#(# ~~_RCR_ԀNo.65#X XXX U#X XXX  $0t+/  16.0  SERVICEANDNOTICETOLAWENFORCEMENTAGENCIES (#(#   _RCR_ԀNo.65   0  Uponthesigningofthisorderbyadistrictcourtjudge,alawenforcementofficershallserveontherespondentacopyofthisorderandacopyofthepetition. (#(#  ALAWENFORCEMENTOFFICERSHALLUSEANYLAWFULMEANSTO $ t ENFORCETHISORDER. [ X ]0  Ihavereviewedthepetitionfororderofprotectionandmaderecommendationstothe  8  districtjudgeregardingitsdisposition. (#(# (505)8274350or(505)82743510  0(#(#_____________________________ (#(#  Courttelephonenumbers0  0h(#(# 0h(#h(#0(#(#MARGARETKEGEL  (#(#    `     h     DomesticRelationsHearingOfficer   0   (#(#  SOORDERED: <  _____________________________ h   ____________________________ d DistrictJudge `     h   Dateandtimeapproved P    `     h _RCR_ԀNo.65  0\+/ #X XXX F# X XXX XX DISTRICTCOURTCIVIL0  0h(#(#0h(#h(#0(#(#0p(#(#SupremeCourtApprovedp(#p(# 4961A   `     h     0 p October29,2008 0xp(#p(#vx(#x(# #X X#0  0` (#(#0 ` (#` (#0 (# (#0h(#(##X XXX ˆ# h(#h(#  FIRSTJUDICIALDISTRICTCOURT (x STATEOFNEWMEXICOCOUNTYOF_____________________    `     h     CaseNo.:D___________________  < ______________________________,   Petitioner       `  v.0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(# (#(# ______________________________,̀Respondent   `  ̀   0 @4 @ SERVICEOFPROCESSINFORMATIONFOR $t 0 @4 @ PETITIONFORORDEROFPROTECTIONFROMDOMESTICABUSE0 @4 @ AND0 @4 @ PETITIONFOREMERGENCYORDEROFPROTECTION1 8 0 @4 @ INFORMATIONABOUTTHERESPONDENT   ___________________________________Respondent'sname___________________________________Respondent'sdateofbirth____________________________________  \ Isrespondentinjail?[]yes[]noIfyes,where?_________________________________________̀Respondent'sphysicaladdressis:______________________________(street)  H ______________________________(city) !4  ______________________________(county) " ! ______________________________(stateandzipcode) # " []Tribe[]Puebloof______________________________Respondent'sworkplace:______________________________(employer'sname) l'"& ______________________________(street) X(#' ______________________________(city) D)$( ______________________________(county) 0*%) ______________________________(stateandzipcode) +l&* []Tribe[]Puebloof______________________________ /+/ Respondentworksthefollowinghours:____________(a.m.)(p.m.)to____________(a.m.)(p.m.)Respondentstelephonenumbersare:Home  0 ` 0 ` (#` (#Work  0h (# (#0h(#h(#Message p L (#(# _________________ _________________  __________________   8   Whatdoesrespondentlooklike?Hair____________(color)0  0h(#(#Eyes____________(color) L h(#h(# Height____________0  0h(#(#Weight____________ 8 h(#h(# Race-ethnicity:______________________________Otherphysicalcharacteristicsormarks:_______________________________________________________________________________________________________.Doyouconsidertherespondenttobedangerous?[]yes[]no.Ifyes,why?____________________________________________________________________________________________________________________.Doesrespondenthaveanyweapons?[]yes[]no.Ifyes,pleasedescribe:________________________________________________.Placeswhererespondentcanbefoundapartfromphysicaladdressandworkplace:______________________________________________________________________.________________________0 h ____________________________________ h(#h(# Date   ` 0 0 (# (#0h(#(#SignatureofPetitioner h(#h(#    `     h _____________________________________0  0` (#(#0 ` (#` (#0 (# (#0h(#(#(Petitioner'sstreetaddressh(#h(#    `     h unlesspetitionerfilesForm4-961B) x  l Ѐ   `  X     `     h _____________________________________   `     h (City,stateandzipcode 0"     `     h unlesspetitionerfilesForm4-961B) x  #l! Ѐ