Rhode Island General Laws Title 15. Domestic Relations § 15-15-6. 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		FAMILY COURT
COUNTY OF ___________________________________________
_____________________________________________________
Plaintiff
VS.		F.C. NO. ______
_____________________________________________________
Defendant

COMPLAINT FOR PROTECTION FROM ABUSE

Pursuant to Chapter 15 of this title, I request that the court enter an order protecting me from abuse.

_____ We (are) (were formerly) married to one another.

_____ I am the defendant's (child) (parent).

_____ I am the blood relative or relative by marriage of the defendant;  specifically, the defendant is my .

_____ I and the defendant are together the legal parents of one or more children.

_____ Threatened or harmed me 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

_____ 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

_____ The court award me temporary custody of the following minor child(ren) (the defendant and I are husband and wife):

Names

Date of Birth

That

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 the order is entered on the question of continuing the temporary order.

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

	__________________________
	Notary Public

Note:  If this complaint is filed by an attorney, the attorney's certificate should appear as 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		FAMILY COURT
COUNTY OF ___________________________________________
_____________________________________________________
Plaintiff
VS.		F.C. NO. ______
_____________________________________________________
Defendant

TEMPORARY ORDER PURSUANT TO CHAPTER 15 OF THIS TITLE GENERAL LAWS OF RHODE ISLAND

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

.

_____ That the plaintiff, being the [husband] [wife] of the defendant, be and [s]he hereby is awarded temporary custody of the minor child[ren], to wit,

_____ That the defendant pay to the plaintiff the support of the minor child[ren] the sum of $__________ per .

_____ That

A hearing on the continuation of this ORDER will be held at the family court, __________ County, at __________ [A.M.] [P.M.] on __________.  If the defendant wishes to be heard, [s]he will be heard at that time.  If [s]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.

ENTERED as an order of court this __________ day of __________, A.D. 20___.