1. (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
   

2. (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.