Complaint For Order Of Protection {FC-79}

FC-79 (revised April 2018) Page 1 of 4 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT COMPLAINT FOR AN ORDER OF PROTECTION Domestic Abuse with Juvenile Involvement Sexual Abuse/Sexual Exploitatio n Domestic Abuse Civil Action File Number Date of Birth Plaintiff Individually and/or as Parent/Guardian of: a. b. c. d. e. v. Defendant Individually and/or as Parent/guardian of: Murray Judicial Complex Newport County 45 Washington Square Newport, Rhode Island 02840-2913 (401) 841-8340 Noel Judicial Complex Kent County 222 Quaker Lane Warwick, Rhode Island 02886-0107 (401) 822-6725 McGrath Judicial Complex Washington County 4800 Tower Hill Road Wakefield, Rhode Island 02879-2239 (401) 782-4111 Garrahy Judicial Complex Providence/Bristol County One Dorrance Plaza Providence, Rhode Island 02903-2719 (401) 458-3200 Pursuant to chapter 15 of title 15 or chapter 37.2 of title 11 of the General Laws of Rhode Island, I request that this court enter an order protecting me and/or my children from abuse. 1. My full name, present street address, city, and state are as follows: . 2. My former residence, which I have left to avoid abuse, is as follows: . American LegalNet, Inc. www.FormsWorkFlow.com FC-79 (revised April 2018) Page 2 of 4 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT 3. The full name, present street address, city, and state of the person causing me abuse (the defendant) are as follows: . 4. I have no knowledge of the existence of other lawsuits, orders of protection, or no contact orders between the parties including: Divorce; separation; child custody; protection orders; and criminal no contact orders. I have not sought a protection order from the Family Court or any other court for the same facts or circumstances alleged in this complaint except for the following. (Please state 223NONE224 or provide the applicable case numbers.) . 5. My relationship to the defendant is as follows. (Check the box that applies.) We are or were formerly married to one another. I am a blood relative or relative by marriage of the defendant; specifically, the defendant is my . The defendant and I together are the legal parents of one (1) or more children. The defendant and I have been in a substantive dating or engagement relationship within the past one (1) year in which at least one (1) of us is a minor. No family or substantive dating relationship exists between the defendant(s) and my children or me. (Check this box only for complaints alleging sexual abuse or sexual exploitation.) 6. I certify that to the best of my knowledge the defendant is not in the military service as defined by the Servicemembers Civil Relief Act (50 U.S.C.A. App. 247 501, et seq.) and is not a member of the national guard on state active duty for a continuous period exceeding ninety (90) days as defined by G.L. 1956 247 30-7-10. 7. On or about , my children and/or I suffered abuse when the defendant: (Check the boxes that apply.) Threatened or harmed my children and/or me with a weapon which was a . Attempted to cause my children and/or me physical harm. Caused my children and/or me physical harm. Placed my children and or me in fear of imminent physical harm. Caused my children and/or me to engage involuntarily in sexual relations by force, threat of force, or duress. American LegalNet, Inc. www.FormsWorkFlow.com FC-79 (revised April 2018) Page 3 of 4 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT Attempted to make my children and/or me engage involuntarily in sexual relations by force, threat of force, or duress. Stalked, cyberstalked, and/or harassed my children and/or me. Sexually exploited and/or sex trafficked my child. For these reasons, I ask that the Family Court: (Check the boxes that apply.) Order that the defendant(s) be restrained and enjoined from contacting, assaulting, molesting, stalking, cyberstalking, harassing, or otherwise interfering with my children and/or me at home, on the street, or elsewhere. Order the defendant(s) to immediately VACATE the household which is located at: . Order that the defendant shall NOT terminate or disrupt any utility service at my residence without a prior court order. Award me temporary custody of the following minor children of whom I am the parent/guardian: . Award me support for my minor children as required by law for a period not to exceed ninety (90) days. Order that the defendant surrender all firearms to the Rhode Island State Police or the local police department or a federally licensed firearms dealer within twenty-four (24) hours of notice (service) of the surrender order. Order 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 my children and/or 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 the temporary order and that at the hearing I will present evidence in support of this complaint. I understand that if I fail to appear at the scheduled hearing date, the Ex Parte Temporary Order of Protection and this Complaint will be dismissed. American LegalNet, Inc. www.FormsWorkFlow.com FC-79 (revised April 2018) Page 4 of 4 STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS FAMILY COURT VERIFICATION OF COMPLAINT I make this complaint under oath and state that the facts and allegations contained herein are true to the best of my knowledge and belief. Name of the Plaintiff or the Defendant Signature Date: State of County of On this day of , 20, before me, the undersigned notary public, personally appeared personally known to me or who proved to me through satisfactory evidence of identification, which was , to be the person who signed above in my presence, and who swore or affirmed to me that the contents of the document are truthful to the best of his or her knowledge. Notary Public: My commission expires: Notary identification number: NOTICE PURSUANT TO G.L. 1956 247 15-15-3(c) A person restrained under G.L. 1956 247 15-15-3(c) shall be ordered pursuant to G.L. 1956 247 11-47-5 to surrender possession of any firearms while the protective order is in effect; and shall be entitled to a hearing within fifteen (15) days of surrendering any firearms. American LegalNet, Inc. www.FormsWorkFlow.com