DC-69 (revised November 2018) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT COMPLAINT AND MOTION FOR TEMPORARY RESTRAINING ORDER 226 LANDLORD AGAINST TENANT Plaintiff Civil Action File Number Defendant Attorney for the Plaintiff or the Plaintiff Address of the Defendant Address of the Plaintiff 222s Attorney or the Plaintiff Murray Judicial Complex 2nd Division District Court 45 Washington Square Newport, Rhode Island 02840-2913 (401) 841 - 8350 Noel Judicial Complex 3rd Division District Court 222 Quaker Lane Warwick, Rhode Island 02886-0107 (401) 822 - 6750 McGrath Judicial Complex 4th Division District Court 4800 Tower Hill Road Wakefield, Rhode Island 02879-2239 (401) 782 - 4131 Garrahy Judicial Complex 6th Division District Court One Dorrance Plaza Providence, Rhode Island 02903-2719 (401) 458 - 5400 The Plaintiff hereby requests that this court enter a Temporary Restraining Order for the reason set forth below. In support of this Complaint and Motion, the Plaintiff states: 1. The Plaintiff is the landlord/owner of the property. 2. The Defendant is the tenant of the rental premises located at: . 3. On or about , without cause or provocation, the Defendant has: Attempted to cause me physical harm. Placed me in fear of imminent serious physical harm. Committed stalking or cyberstalking against me. Specifically, the Defendant . Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com DC-69 (revised November 2018) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT 4. The Plaintiff contacted or attempted to contact the Defendant to tell the Defendant of this request for a Temporary Restraining Order by doing the following: . WHEREFORE, the Plaintiff asks this court to: 1. Enter a Temporary Restraining Order restraining the Defendant from contacting, assaulting, or otherwise interfering with the Plaintiff at home, on the street, or elsewhere; and 2. Grant such further relief as this court deems fit and proper. I, , after being duly sworn, depose on oath and state that I am the Plaintiff in the above-entitled case, and I have personal knowledge of the matters to which the Complaint refers, and that these matters are true and correct to the best of my knowledge and belief. Name of the Plaintiff Signature of the Plaintiff Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com DC-69 (revised November 2018) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT State of County of On this day of , 20, before me, the undersigned notary public, personally appeared personally known to the notary or 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: ATTORNEY CERTIFICATE /s/ Attorney for the Plaintiff Rhode Island Bar Number: Date: Office Telephone Number: Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com DC-69 (revised November 2018) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT LANDLORD RESTRAINING ORDER AGAINST TENANT - AFFIDAVIT Plaintiff Civil Action File Number Defendant I, , on oath do depose and state as follows. 1. My name is 2. I reside at . 3. My tenant is . 4. The following has occurred: Name of the Plaintiff Signature of the Plaintiff Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DC-69 (revised November 2018) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT State of County of On this day of , 20, before me, the undersigned notary public, personally appeared personally known to me or 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: Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DC-69 (revised November 2018) STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT TEMPORARY RESTRAINING ORDER - LANDLORD AGAINST TENANT Plaintiff Civil Action File Number Defendant Attorney for the Plaintiff or the Plaintiff Address of the Defendant Address of the Plaintiff222s Attorney or the Plaintiff Upon consideration of the Complaint and Motion for Temporary Restraining Order, and having found likelihood of immediate and irreparable harm to the Plaintiff, it is hereby ORDERED, ADJUDGED, and DECREED as follows: 1. That the Defendant is restrained and enjoined from contacting, assaulting, or otherwise interfering with the Plaintiff at home, on the street, or elsewhere. 2. That the Plaintiff is granted the following relief: . 3. That this order shall remain in effect until a hearing on the Temporary Restraining Order which shall be held on the day of , 20 at 9:00 a.m. in the District Court at the address indicated on the Summons served with this Restraining Order. Entered as an Order of the court on . BY ORDER OF: /s/ Clerk ENTER: /s/ Judicial Officer American LegalNet, Inc. www.FormsWorkFlow.com