Rhode Island General Laws Title 15. Domestic Relations § 15-15-6. Form of complaint

(1) My full name, present street address, city, and telephone number are as follows: ____________________________________________________________________

______________________________________________________________________

(2) My former residence, which I have left to avoid abuse, is as follows (street address and city): ____________________________________________________________________

______________________________________________________________________

(3) The full name, present street address, city, and telephone number of the person causing me abuse (the defendant) are as follows:

______________________________________________________________________

(4) My relationship to the defendant is as follows:

______ 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 in common.

______ I and the defendant have had a substantive dating or engagement relationship.

______ I am a parent of a minor child(ren) in my care or custody, to which defendant is not a blood relative or relative by marriage.

(5) On or about ________________________________, I suffered abuse when the defendant:

______ 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

(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

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

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.

(7) I have not sought protection from abuse from any other judge of the family court arising out of the facts or circumstances alleged in this complaint.

(8) That the court award me support for my minor children as required by law for a period not to exceed ninety (90) days.