(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 |
(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 |
History of Section.
P.L. 1985, ch. 492, § 2; P.L. 1988, ch. 539, § 4; P.L. 1989, ch. 78, § 2; P.L. 1995, ch. 145, § 1; P.L. 2021, ch. 77, § 4, effective June 23, 2021; P.L. 2021, ch. 78, § 4, effective June 23, 2021.