COMMONWEALTH OF MASSACHUSETTS ______________SS: HOUSING COURT DEPARTMENT ____________________ DIVISION CIVIL ACTION NO. / / / - / / / / / / _____________________________ PLAINTIFF(S) VS. _____________________________ DEFENDANT(S) VERIFIED COMPLAINT, and MOTIONS FOR TEMPORARY RESTRAINING ORDER and PRELIMINARY INJUNCTION FOR UNLAWFUL EVICTION, UTILITY TERMINATION OR BREACH OF QUIET ENJOYMENT (G.L. c. 186, 14) Part 1: NAME OF PLAINTIFF(S) (the tenant ): ___________________________________________ ADDRESS (of apartment or rental house): _________________________________________ ______________________________________________________________________ ______ TELEPHONE NUMBER: ______________________________________________________ Part 2: NAME OF DEFENDANT (the landlord): __________________________________________ ADDRESS: _____________________________________________________________ _____ TELEPHONE NUMBER: ______________________________________________________ Part 3: A. On or about (date) ______________________________, the defendant (landlord): G Locked me out of the premises or otherwise attempted to regain possession of the premises without judicial process. G Turned off or failed to restore the utilityservice (heat, gas, electricity , hot water, water). G Otherwise directly or indirectly interfered with my quiet enjoyment of the premises. Specifically explain what happened: (Use additional pages if necessary.) ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ ________________________________________________________________________ ____________ American LegalNet, Inc. www.USCourtForms.com>>>> 2 -2- B. By engaging in the above acts, the defendant/landlord has cost me the following sums of money (fill this in only if tenant wishes to claim specific money losses): List of Expenses/Property Loss: ITEM AMOUNT _______________________________________ $________________ _______________________________________ $________________ _______________________________________ $________________ _______________________________________ $________________ _______________________________________ $________________ _______________________________________ $________________ _______________________________________ $________________ +________________ TOTAL: $ ________________ C: My landlord is therefore liable to me for three (3) times the above amount or three (3) times my monthly rent, $_________________ (enter amount) whichever is larger. (G.L. c. 186, 14, 15F). Part 4: THEREFORE , I ask that the Court: A. Issue a Temporary Restraining Order, Preliminary Injunction, and Permanent Injunction restraining and enjoining the defendant from (check where appropriate): ________ Denying me possession of the premises; ________ Depriving me of utility service; ________ Denying me possession of my personal belongings; ________ Otherwise interfering with my right to quiet enjoyment of the premises. B. Award me money damages in the amount of $_____________ (the greater of three (3) times monthly rent or actual damages) plus costs. C. Award such other relief as the Court deems appropriate. D. Issue a Short Order of Notice. American LegalNet, Inc. www.USCourtForms.com>>>> 3 -3- E. Schedule a Preliminary Injunction Hearing prior to the expiration of any Temporary Restraining Order that my be granted. Respectfully submitted, _________________________________ PLAINTIFFS SIGNATURE _________________________________ ADDRESS _________________________________ _________________________________ Telephone VERIFICATION I, _______________________________, have personal knowledge of all of the facts stated above and hereby swear under the pains and penalties of perjury that all of those facts are true and accurate. _________________________________ _______________________________________ DATE: SIGNATURE American LegalNet, Inc. www.USCourtForms.com