§ 11-37.2-7 Form of complaint. – (a) A form in substantially the following language shall suffice for thepurpose 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 courtenter an order protecting me from abuse.
(a) My full name, present street address, city and telephonenumber are as follows:
(b) The full name, present street address, city and telephonenumber of the person causing me abuse (the defendant) are as follows:
(c) On or about ]]]]]]]]]]]]]]]]]], without cause orprovocation, 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 sexualrelations by force, threat of force or duress;
[ ] Attempted to cause me to engage involuntarilyin sexual relations by force, threat of force or duress;
[ ] The court order that the defendant berestrained and enjoined from contacting, assaulting, molesting or otherwiseinterfering with the plaintiff at home, on the street or elsewhere.
[ ] I request that the above relief be orderedwithout notice because it clearly appears from specific facts shown byaffidavit or by the verified complaint that I will suffer immediate andirreparable injury, loss or damage before notice can be served and a hearinghad thereon. I understand that the court will schedule a hearing no later thantwenty-one (21) days after such order is entered on the question of continuingsuch temporary order.
(e) I have not sought protection from abuse from any otherjudge of the district court arising out of the same facts or circumstancesalleged in this complaint.
(Signature) (Date)
Subscribed and sworn to before me in ]]]]]]]]]]]]]]]]]] inthe County of ]]]]]]]]]]]] in the State of Rhode Island and ProvidencePlantations, this ]]]]]]]]]]]] day of ]]]]]]]]]]]]]] A.D. ]]]]]]]]]]]]]]]]]]
Notary Public
Note: If this complaint is filed by an attorney, theattorney'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 shallsuffice for the purpose of requesting temporary orders under this chapter:
§ 11-37.2-7 Form of complaint. – (a) A form in substantially the following language shall suffice for thepurpose 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 courtenter an order protecting me from abuse.
(a) My full name, present street address, city and telephonenumber are as follows:
(b) The full name, present street address, city and telephonenumber of the person causing me abuse (the defendant) are as follows:
(c) On or about ]]]]]]]]]]]]]]]]]], without cause orprovocation, 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 sexualrelations by force, threat of force or duress;
[ ] Attempted to cause me to engage involuntarilyin sexual relations by force, threat of force or duress;
[ ] The court order that the defendant berestrained and enjoined from contacting, assaulting, molesting or otherwiseinterfering with the plaintiff at home, on the street or elsewhere.
[ ] I request that the above relief be orderedwithout notice because it clearly appears from specific facts shown byaffidavit or by the verified complaint that I will suffer immediate andirreparable injury, loss or damage before notice can be served and a hearinghad thereon. I understand that the court will schedule a hearing no later thantwenty-one (21) days after such order is entered on the question of continuingsuch temporary order.
(e) I have not sought protection from abuse from any otherjudge of the district court arising out of the same facts or circumstancesalleged in this complaint.
(Signature) (Date)
Subscribed and sworn to before me in ]]]]]]]]]]]]]]]]]] inthe County of ]]]]]]]]]]]] in the State of Rhode Island and ProvidencePlantations, this ]]]]]]]]]]]] day of ]]]]]]]]]]]]]] A.D. ]]]]]]]]]]]]]]]]]]
Notary Public
Note: If this complaint is filed by an attorney, theattorney'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 shallsuffice for the purpose of requesting temporary orders under this chapter:
§ 11-37.2-7 Form of complaint. – (a) A form in substantially the following language shall suffice for thepurpose 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 courtenter an order protecting me from abuse.
(a) My full name, present street address, city and telephonenumber are as follows:
(b) The full name, present street address, city and telephonenumber of the person causing me abuse (the defendant) are as follows:
(c) On or about ]]]]]]]]]]]]]]]]]], without cause orprovocation, 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 sexualrelations by force, threat of force or duress;
[ ] Attempted to cause me to engage involuntarilyin sexual relations by force, threat of force or duress;
[ ] The court order that the defendant berestrained and enjoined from contacting, assaulting, molesting or otherwiseinterfering with the plaintiff at home, on the street or elsewhere.
[ ] I request that the above relief be orderedwithout notice because it clearly appears from specific facts shown byaffidavit or by the verified complaint that I will suffer immediate andirreparable injury, loss or damage before notice can be served and a hearinghad thereon. I understand that the court will schedule a hearing no later thantwenty-one (21) days after such order is entered on the question of continuingsuch temporary order.
(e) I have not sought protection from abuse from any otherjudge of the district court arising out of the same facts or circumstancesalleged in this complaint.
(Signature) (Date)
Subscribed and sworn to before me in ]]]]]]]]]]]]]]]]]] inthe County of ]]]]]]]]]]]] in the State of Rhode Island and ProvidencePlantations, this ]]]]]]]]]]]] day of ]]]]]]]]]]]]]] A.D. ]]]]]]]]]]]]]]]]]]
Notary Public
Note: If this complaint is filed by an attorney, theattorney'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 shallsuffice for the purpose of requesting temporary orders under this chapter:
