Statutes: Rhode Island

(a) A form in substantially the following language shall suffice for the purpose of filing a complaint under this chapter:

STATE OF RHODE ISLAND	DISTRICT COURT
COUNTY OF ___________	_______ DIVISION

Plaintiff
VS		NO:
Defendant

COMPLAINT FOR PROTECTION FROM ABUSE

Pursuant to chapter 8.1 of title 8 I request that the court enter an order protecting me from abuse.

(1) My full name, present street address, city and telephone number are as follows:

(2) My former residence, at which I resided with the defendant, is as follows (street address and city):

(3) My former residence is a house

I own

Defendant owns

We jointly own

My former residence is an apartment

There is no lease

My name is on lease and defendant’s is not

Defendant’s name is on lease and mine is not

Both our names are on lease

(4) The full name, present street address, city and telephone number of the person causing me abuse (the defendant) are as follows:

(5) On or about__________, without cause or provocation I suffered abuse when the defendant:

__________Threatened or harmed with a weapon:

(type of weapon used:__________)

__________Attempted to cause me physical harm;

__________Caused me physical harm;

__________Placed me in fear of imminent physical harm;

__________Caused me to engage involuntarily in sexual relations by force, threat of force, or duress specifically, the defendant: __________

(6) I ask that:

__________The court order that the defendant be restrained and enjoined from contacting, assaulting, molesting or otherwise interfering with the plaintiff at home, on the street or elsewhere.

__________The court order the defendant to immediately leave the household which is located at

I request that the above relief be ordered without notice because it clearly appears from specific facts shown by affidavit or by the verified complaint that I will suffer immediate and irreparable injury, loss, or damage before notice can be served and a hearing had thereon. I understand that the court will schedule a hearing no later than twenty-one (21) days after such order is entered on the question of continuing such temporary order.

(7) I have not sought protection from abuse from any other judge of the district court arising out of the same facts or circumstances alleged in this complaint.

(Signature)		(Date)

Subscribed and sworn to before me in __________ in the County of __________in the state of Rhode Island, this __________ day of __________ A.D. 20___.

	Notary Public

Note: If this complaint is filed by an attorney, the attorney’s certificate should appear below:

ATTORNEY CERTIFICATE

Signed:
	Attorney for Plaintiff
Address:

Date:	,	19____
	WHITE COPY	___ Court
	YELLOW COPY	___ Plaintiff
	PINK COPY	___ Defendant
	GOLDENROD COPY	___ Police Department

(b) A form in substantially the following language shall suffice for the purpose of requesting temporary orders under this chapter:

STATE OF RHODE ISLAND	DISTRICT COURT
COUNTY OF ___________	_______ DIVISION

Plaintiff
VS		NO:
Defendant

(TEMPORARY) ORDER PURSUANT TO CHAPTER

__________OF THE G.L. OF R.I.

Upon consideration of plaintiff’s complaint, (and having found that immediate and irreparable injury, loss or damage will result to the plaintiff before a notice can be served and a hearing had thereon) it is ORDERED:

__________That the defendant is restrained and enjoined from contacting, assaulting, molesting, or otherwise interfering with plaintiff at home, on the street or elsewhere.

__________That the defendant vacate forthwith the household located at

A hearing on the continuation of this ORDER will be held at the District Court, __________County, __________Division, at (A.M.) (P.M.) on__________. If the defendant wishes to be heard, she/he will be heard at that time. If she/he does not appear at that time, this ORDER shall remain in effect.

This ORDER is effective forthwith, and will remain in effect until the time and date of the above-mentioned hearing.

A copy of this ORDER shall be transmitted to the appropriate local law enforcement agency forthwith, and shall be served in-hand on the defendant herein.

ENTERED as an Order of Court this __________ day of __________ A.D. 20___.

ENTER:		PER ORDER
Judge		Clerk
Presented by:
		Attorney for Plaintiff

	WHITE COPY	–	Court
	YELLOW COPY	–	Plaintiff
	PINK COPY	–	Defendant
	GOLDENROD COPY	–	Police Department