R.I. Gen. Laws § 8-8.1-6. Form of complaint.
(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: ___________ , 20__ WHITE COPY ___ Court YELLOW COPY ___ Plaintiff PINK COPY ___ Defendant GOLDENROD COPY ___ Police Department
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
My former residence is an apartment
(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:
_____ 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.
Subscribed and sworn to before me in ____________ in the County of ____________ in the state of Rhode Island, this ________ day of ____________ A.D. 20_____ .
Note: If this complaint is filed by an attorney, the attorney's certificate should appear below:
(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
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