(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.
(a)(1) My full name, present street address, city and telephone number are as follows:
_________
(b)(2) The full name, present street address, city and telephone number of the person causing me abuse (the defendant) are as follows:
_________
(c)(3) 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;
[ ] Attempted to cause me to engage involuntarily in sexual relations by force, threat of force or duress;
Specifically, the defendant: _________
_________
(d) 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.
[ ] 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.
(e) 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. _________
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: _____________________________________________________________________
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:
History of Section.
P.L. 2009, ch. 239, § 1; P.L. 2009, ch. 240, § 1; P.L. 2021, ch. 77, § 11, effective June 23, 2021; P.L. 2021, ch. 78, § 11, effective June 23, 2021.