Title 11
Criminal Offenses

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

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.